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ALIF only lasts possibly 5 years??

edited 06/11/2012 - 7:47 AM in Lower Back Pain
Hi everyone

Ive just been recommended that after numerous intervention, a ALIF for L5/S1 is an option for DDD and failed previous microdiscectomy.

My consultant has told me to go back to see him in 6 weeks with plenty of questions to ensure I am happy to proceed then he will put me on the waiting list (uk).

One thing im trying to find info on is how long a fusion may give benefit for. He's given me a 60-70% chance of being better, which i think is fine. My only concern is that he says being only 29, I may only have the benefit for 5 years?

Anyone heard this, or any indications on how long benefits can last?

Carol x
L5/s1 discectomy & decompression 2009
ALIF l5/s1 2011
Awaiting X-ray & consultant to see if fused, but experiencing a lot of pain again :( 2013
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Comments

  • i don't think we have talked so... hi .regarding the length of time a fusion will last depends on a few things the main one is are you the right person to be having a fusion and is your consultant up to the job ?? the reason i mention this is because i have been turned down for surgery by 4 surgeons and i have found one that's wanting to do my multilevel fusion soon {i hope } but the others have said i am not suitable for more surgery {already had 2 operations } and wanted to keep my just on pain killers until i dropped i guess! but this consultant says that he get people like me {that have been turned down }all the time .so my advice make sure that you do your home work and get a top surgeon and dont rush into surgery.. you will more than likely need revision surgery in about ten years max and every ten years .are you suitable for ADR {replacement disc} because that may work out better for you
    good luck with what you decide
    tx
  • There is no set time frame. You could get a lifetime of benefits or no benefit. Every one is different.

    Dave
  • Hi straker and dave, no i dont think we've chatted. ive been more of a lurker, sponging as much information as i can from the website and forum which i think is amazing.

    You know what its like as it sounds like you have been through so many consultations they get tiring. ive been to see, 1 othopaedic (did microdisectomy), 1 neurosurgeon who didnt do fusions, 1 othopaedic with spine fellowship who recommended PLIF and now this new orthopaedic with spine fellowship who says he prefers the ALIF approach due to minimal blood loss as he isnt cutting through muscles.

    The ALIF worries me as it has to move the great vessels, i think thats my only fear, oh and the scarring being i already have 2 scars from appendicectomy and one other from a laparoscopy, but then i wont wear bikinis, so its one of them isnt it. He was very thorough in detailing the risks which scared the pants off me, but i feel i have to take the opportunity to at least get some life back.

    Im desperate for a pain free or at least better quality of life than i have now. with him saying 5 years, in one respect im still young enough to "cope" with a revision although i wouldnt want to keep having ops, but then i cant go on like this.
    Ive just had a really bad few nights, unable to sleep for the pain even though im on Butrans patch, gabapentin, diazepam and paracetamol. i occasionally also take dihydrocodeine.

    So far ive written 22 questions, as i would like to see if he would consider ADR as it is in the NICE guidelines. I never thought to ask him, only because the last ortho i saw with spine fellowship said i wasnt a candidate, but stupidly i didnt question why, at the time i was in a state of europhia as i finally felt my complaints were finally being confirmed and verified.

    I feel ADR would be better for me taking into account my age, i will definately investigate this.

    Straker - ive read on the forum your planning a 360 fusion, is this a PLIF and ALIF in same op?

    Thank you very much to you both for your replies.

    carol x
    L5/s1 discectomy & decompression 2009
    ALIF l5/s1 2011
    Awaiting X-ray & consultant to see if fused, but experiencing a lot of pain again :( 2013
  • I found a study that studied different factors in reoperation and ended up with a kind of probability chart showing probability of reoperation based on the surgeon's volume of operations. Interesting!

    But anyway, here is the chart they found giving the probability out to 10 years that you will survive without reoperation.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724822/figure/f2-0520283/

    It still looks like a good 85% after 10 years based on their population. Also, the numbers were higher for high-volume surgeons than low-volume surgeons (meaning more patients survived without reoperation).

    Thought that might be interesting to you!
  • Thank you happyHBmom, im going to have a good read of it. Ive been trying to find evidence based research etc so i can go in 6 weeks with a fully informed decision.

    Really grateful

    carol x
    L5/s1 discectomy & decompression 2009
    ALIF l5/s1 2011
    Awaiting X-ray & consultant to see if fused, but experiencing a lot of pain again :( 2013
  • Here's the whole article:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724822/

    in case it isn't easy to get back to from the charts.
  • This one uses metaanalysis (uses data already out there but new data analysis techniques) to compare fusion and disk replacement and finds no signficant difference between re-operation rates or complication rates at 2 and 5 years.

    A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease.

    http://www.springerlink.com/content/f736758kn4q6150x/

    (sorry, no full text on this one!)
  • Your post intrigued me, as I am 6 weeks post L4-5, ALIF, and there was never a time frame given to me, there was discussion as to eventually fusing the level above.
    Perhaps in the US the docs keep this info to themselves??

    Why would an anterior approach have a lesser hold compared to a posterior?? Especially when going through the front less actual spine and nerves are bothered in the procedure.
    Any thoughts follow spineys?

    Best of luck Carol and hopefully your are not waitlisted too far out, I've heard it can be a long wait in the UK. Sorry to hear that you are suffering so, I know what you feel and it stinks! I went anterior as you stated no back muscles cut, all abdominal was retracted, and everything, I mean everything is moved, and my organs are still yelling at me! I went anterior as I was told it would be a quicker recovery, I am still waiting.

    On ADR, I think it is more common in Europe, here I believe to be a candidate, your issue most be confined to one level, I may be incorrect, but that is what I've been told.
    Good job making a list of questions, be sure doctor answers them all to your complete understanding.

    Pain free days.... for all
    Virginia
  • No the ALIF wasnt said to have a lesser hold, it is just his preferred way of operating due to it being less vascular and he described it as being more able to remove more disc than PLIF.

    But yeah, by him saying ALIF 5 years, makes it come across as less time than PLIF, but then Ive not been told success in years for PLIF.

    Hmm, im wondering if he's basing it on that im 29 and its assumed i would be more active being im a ward nurse and on my feet all the time, running round etc. Maybe not? im very confused, thats another question ive wrote down !lol!

    He told me the recovery is quicker too like yours did. He said it'll hurt like hell initially, but you'll recovery so much better.

    Would you mind (only if you are able, totally understand you are fitting things in between pain/discomfort), just to tell me a little about your operation, and the recovery you have to date?

    Thanks

    Carol x
    L5/s1 discectomy & decompression 2009
    ALIF l5/s1 2011
    Awaiting X-ray & consultant to see if fused, but experiencing a lot of pain again :( 2013
  • they do fusions at the drop of a hat i have talked to people as young as 19 having that kind of surgery .i have been told that even at 44 i am young to be considering a 360 fusion {carol as far as i know the 360 is a combination of what you mentioned }and its easier for the surgeon if he /she has access to both side of your spine .it gives better stability ..i am just hoping that my consultant is as good as everyone says and his work is top as i don't want any complications .i have been told that i am high risk and its a gamble ..but one i should consider as to carry on as i am in not an option anymore ..too much suffering and too many restrictions on my and my wife life .i hope to be in the OR withing the next 6/8 weeks {sue this will be the time when my roof will be being replaced!}
    tx
  • Carol, I will PM u later today and give you my take, which may not be usual or what others have experienced. I had a couple of minor complications and yes, initial pain is rather extreme, has calmed down a bit, but still pretty bad, more then I had anticipated. Especially considering my current meds.
    Look for my message in your inbox.
    Take care!
    Virginia
  • you are young, looking at your signature your spine ops started at 31. I really hope and pray that your 360 fusion is going to address and give you back the life we all want. Is really rough on us, but also our friends and familys. People with no back issues, i feel, dont really see the bigger picture. Sadly, throughout my back issues which have been intense this last 12 months, ive lost friends. Ive not lost them in the way we fell out, they just stopped popping in and calling.

    6-8 weeks is fantastic, it will soon be here. Sooner rather than later. i think all back ops are gambles, but obviously more so in your case (ive read a few of your posts, you sound so debilitated, but keeping your head up :) ) You have been given an opportunity and chance to get better quaility of life, its still bloody scary though isnt it.

    Are you high risk because of previous op's/high tolerance of pain meds?
    Im having my op in lancashire, where in uk will you be having yours?

    Virginia - oh thank you so much, ive just spotted your message.

    carol x



    L5/s1 discectomy & decompression 2009
    ALIF l5/s1 2011
    Awaiting X-ray & consultant to see if fused, but experiencing a lot of pain again :( 2013
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