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plf,alf,tlif,plif,tlif,360...??

ouch2oouch2 Posts: 1,270
edited 06/11/2012 - 7:48 AM in Back Surgery and Neck Surgery

Hi everyone, I am fairly new to this site. I injured my back 5 1/2 months ago. Extreme low back/buttocks pain, with tingling, numbness in left leg. I have tried PT,accupunture, cortizone epiderals, and am currently on ms contin 15 3 times a day and percocet 4-5 times a day with limited relief. I have impingement on my nerve and disc collapse on l4/l5 l5/s1 . I am going to be having a spinal fusion, just waiting for ortho to refer me to another surgeon who does fusions, as he only does plf, and he believes that I need an interbody fusion. I have been trying to learn about all the different types of fusions to try to figure out which type would be best? Can anyone tell me how it is decided on which type of fusion, whether it depends on the exact problem or is more the surgeons preference in terms of anterior or posterior? The 360 sounds like it would give the most stability but I'm not sure, and can I request to have a 360 or just go with what the surgeon thinks? Sorry for long post and look forward to hearing your insight.
>:D< >:-D< : Karen
L3-S1 herniation and bulges, stenosis, mod facet,ddd,impinged nerves,coccydinia
discectomy/lami July 2011-unsuccessful
adr L5-S1 Feb 2012
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Comments

  • Hi, Sorry you are having lower back issues...no fun!
    I herniated my L5-S1 disc a year ago. It was bad. Similar to you, lost feeling in my leg, buttocks, foot. I didn't have the chance to try ESI or shots. I tried steroids but they did nothing.

    Anyhow, I had a microdiscectomy (similar to laminectomy) which, instead of fusing, they actually go in and cut away a little of the bone on the vertabrae and then they remove the disc that's herniated out of the spinal column that is compressing the nerve. I had to have this surgery twice but seems to be working 'relatively' well.

    As for types of fusions, definitely visit a few doctors.

    1) ALIF - is from the front; original approach and some still practice it because the feeling is you don't dirupt back muscles which may help with recovery. The downside is you need a vascular surgeon because your organs are all there.

    2) PLIF/TLIF - sometimes are interchangeable these days but they are from the back/back side.
    The positive here is that your neurosurgeon or orthospine surgeon goes in without disrupting stomach muscles. The downside is that they may not be able to remove all the disc before putting the spacer between the vertabrae. There is a minimally invasive TLIF but the only thing minimally invasive is the size of the incision. They still put the rods and screws in so it's still a big surgery.

    3) 360 which is both front and back -> I'm still not clear on why one would need this approach b/c it's quite invasive. My understanding is this approach is sometimes used when they need to stablize the spine. This was something no doctor wanted to perform on me for my situation.

    4) There is also XLIF which is newer and not covered by all insurance companies. It's got it's pros/cons. The pro is supposed to be recovery time but the con is that it's newer so the success rates are not there. It's minimally invasive (similar to how I explained TLIF) but they surgeon is working with series of images to help guide them

    5)Artificial Disc Replacement (ADR) is a great option but unfortunately in the US is only approved for 1 level and certain conditions must be met. The reason is because the data isn't there on what happens if it fails.

    I have a bunch of links and there are great links on this site to explain the different procedures.

    Let met try to find some and post here.
    I think you are doing the wise thing and asking here.
    We can also help provide you with a list of Questions to ask the various opinions or surgeons.

    I recommend getting a few opinions to find a surgeon you are comfortable with both short and long term.

    I started with a fellowship trained OrthoSpine doctor but my doctor now is a neurosurgeon.
  • Hi,

    It's alright to ask your surgeon about the different approaches but I think a good surgeon will use the approach which is the very best for the patient. You want to get good results, even if getting there may be more painful or a longer recovery than another approach might have. I'm 3 1/2 weeks post-op 2-level PLIF and doing great. Am cutting way down on my pain pills and expect to not be using any (or minimally) in the next few days. :)
    Linda

    2009 Foraminotomy C6-72010 PLIF L4-S1Multi RFA's, cervical inj, lumbar injLaminectomy L3-4 and fusion w/internal fixation T10-L4 July 17Fusion C2-C5 yet to be scheduled

  • Hi Ouch2~ I am 8 weeks post-op PLIF L4 & L5 discs removed. I completely identified with your pain/symptoms. I agree with Linda, I did not know all the different approachs, trusted my surgeon to come up with the right combination for me. For instance, I have had 2 S-Cections so anterior approach he felt was not for me. Your surgeon will qualify you,and based on that he or she will make the determination. Good news is that my R leg sciatica nerve symptoms which were like your L leg symptoms and intensely painful, are 95% GONE!.Teitrating down on my meds next week and grateful that pre-surgery pain is history. Wishing you a successful surgery, keep us posted.~ Julie David
  • Hi there. I am so happy for you. I too am in a situation with my L5S1 my right leg has pain from my buttocks to the back of my thigh then over to the right side of my leg all the way to the ankle. My left foot is numb the majority of the time now.

    I work many hours and my big problem is sitting and standing. Only the pain pills, stretches, ice packs, traction and pt massage help me get thru the week.

    The L4 is not bone to bone as the L5S1 yet the surgeon wants to fuse that one also because of the severe pain.

    You mentioned the removed the disc that is herniated i know both of mine are mostly the L5S1 but what happens when the remove the disc how are you kept together? Fused or how. Help me to understand before I submit to fusing. All you information is correct regarding the reason for going in thru the abdomen but why fusion for me and not yours. Yours sounds less invasive.

    Help please. I am better now when it comes to my mental health. I was becoming more and more depressed but praise God changed form effexor back to prozac and wellbutrin,. I take vyvanse because i can't concentrate it is so difficult and it helps to wake up after two to three muscle relaxers at night.

    I take oxycontin 20mg twice or three times a day and oxycodone 15mg up 4 or 5 times a day to break the severe pain. Plus anti inflammatory, constipation is severe. But I now look to the future of recovery instead of I cant deal with this any longer.

    The list of meds go on and on...Tomorrow they will call me schedule both the knee surgery and the back surgery.

    any thing anyone might think I need to ask or do before going into surgery I appreciate.

    Thank you.
  • I had a 360 l4/l5-l5/s1 fusion in Febuary. It seems like the recovery is longer than with a plif or alif, but i have more stability and my leg and nerve pain in totally gone! i was in icu for 6 days due to blood lose and irregular heart beats, but i feel like it was the surgery i needed. im about 60% fused and still take 4 percocets a day but feel stronger every week. hope this helped!
    Cora
  • Dnice- thanks for your info about the different types of fusions and glad to hear that you are doing relatively well.
    bebe_pain - you sound similiar to me in that my l5/s1 is basically bone on bone and l4/l5 is getting there. wishing you all the best in both your knee and back surgeries :)
    Linda and Julie David - thanks for the advice about surgeon chosing what is best for the patient. It is so great to hear that you are both doing so well so soon post surgery. It is very encouraging to hear. Keep it up and wishing you continued pain relief and bone fusion.
    This site is full of wonderful caring people full of good thoughts and sharing of their own experiences. I am very grateful to have found this site.
    I have only been going through this for 5 1/2 months and my heart goes out to all of you who have suffered so much longer, I don't know how you do it. I am in such terrible pain 24/7 and can't imagine going through this for a long period of time...though I know that it will be some time before I have my surgery. I find it is getting harder to do the simple things of daily life and walking is becoming very difficult as each step causes shooting pain.
    Wishing you all some painfree days ahead...
    >:D< >:-D< : Karen
    L3-S1 herniation and bulges, stenosis, mod facet,ddd,impinged nerves,coccydinia
    discectomy/lami July 2011-unsuccessful
    adr L5-S1 Feb 2012
  • Hi Cora! Glad to hear you are doing much better.

    Question I had TLIF PLIF 360 fusion. 22 staples in front and it looks like 12 or 13 staples in the back.
    How did they go in for the 360?
    The form of exercise if walking. I still can't sit thru a movie. I learned my lesson.

    I am not to have therapy until 3 months after surgery.

    I need to go back to work by February what can I do to strengthen my back, knees and legs. I am an accountant and sit 99% of the time.
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