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TLIF to PLIF on the OR table

krittylukkrittylu Posts: 14
edited 06/11/2012 - 8:49 AM in Back Surgery and Neck Surgery
Just need someone who might understand. got some information today that my surgeon did a completely different surgery than the one I signed on for. Additionally, he put something in my back that is still undergoing clinical trials and is contraindicated for some one of my size. Was told I was getting a tlif which is a minimally invasive surgery. Ended up with a PLIF which totally destroys back muscles vs a tlif. We are talking a 3 inch incision vs the 9 inch incision I ended up with. I know he did the interbody fusion but instead of the GOLD standard of rods and Pedicle screws he installed an Aspen Interspinous Process device which as I said is still undergoing clinical trials. but something is seriously wrong when he did a surgery that was never on the table (so to speak) in the first place.


  • Do you have a copy of your surgery consent form from the hospital?

  • Just thought I'd give your a little info on the difference between TLIF and PLIF.

    In a TLIF, the surgeon accesses your spine from one side; it is unilateral access. He/she will make a small incision that line up with your foramen, and then they will operate on your spine through that incision and through the foramen; that's why it's called a transforaminal procedure.

    In a PLIF—posterior lumbar interbody fusion—the surgeon accesses your spine more from the middle of your back. Posterior in doctor-speak means "from the back side" (the opposite of this is anterior, or "from the front side"). For a PLIF, the surgeon makes incisions on your back that line up with the middle of your vertebra.

    Both procedures can be performed utilizing minimally invasive techniques. A lot of surgeons probably use those two terms interchangeably and might decide access during the surgery. As for the hardware, you might want to ask them whats up. It would be better to tread lightly with your questioning if your still under their care. No sense putting them on the defensive if you still need them to help you.

  • Am not interested in putting anyone on the defensive. I really like this doc. I'm sure he did the best, I guess I was just surprised and not expecting the change.
  • SpineAZSpineAZ WiscPosts: 1,084
    Often when undergoing surgery the consent form mentions to some degree that if they are unable to fix it one way they may do it with another method. Years ago when I had my gallbladder out laparoscopically the consent form said if unable to do so they'd have to do the open surgical method which has a long painful recovery. So perhaps there was something on the release and consent forms you signed that said if they could not do a less invasive version they'd have to go to a more invasive surgery to fix the problem.

    With my neck and back I have spoken with the surgeon before hand to let them know I give them permission to do whatever is necessary even if it's not on the form.

    In regards to a device undergoing clinical trials it seems that it would be hard for the doctor to do this without your specific authorization AND with insurance company approval. However, often the doctor can write up a justification to insurance as to what would lead to another approach/device. I do see that under some insurance the Aspen Spinous Process is considered investigational. So I'm also wondering if your surgeon's approach is to pre-request approval by insurance in case the other approach to surgery is not viable. From what I read the Aspen Spinous Process is considered less invasive than pedicle screws so the size of your incision must include multiple levels of fusion.

    I would say that just for your own records get a copy of all your records from that surgery and hospitalization.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Back surgery is like Christmas -- you wake up and see what you got. It may be a new bike, and it may be a bag of coal. I thought I was going in for TLIF. I woke up with PLIF (from both sides of my spine [i.e., a 8-inch incision on BOTH sides of my spine]) and the news that four days later I would be having surgery from the front since they couldn't get my damaged discs out through the back. The docs have to do what they have to do to fix you the best way they can. Would you rather that you awoke to have them say, "sorry, we couldn't manage the surgery the way we had planned, so we did a half-a%#ed job and sewed you back up"? I don't think so. You'd want them to do what they decided would be best for you while you were out.

    Relax with it and do your best to heal. After all, what else can you do?

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • I agree with you completely Linda! I think my initial shock was just a quick reaction. I adore this doctor and the bottom line is that my only job at this point is to move forward and do everything I can do in my power to heal.

    I have entrusted him with the decision and bottom line is I would have done (and have done) everything he suggested and/or recommended to get rid of the daily pain that was stopping me from "living" life to the fullest. He went to school for years to help people like me, and while maybe I'm an information hound, I am not a trained neuro who has years of experience.

    The best part of being with fellow spineys is that it frees me to move through these(very necessary) emotions.

    Thanks for sharing Linda!
  • To adjust mentally to the change Krittylu - I was to have an anterior fusion on Dec 13th and they called my husband an hour into the surgery and said they had to back out due to the risk from my vein placement so I woke up with a PLIF with 4 incisions due to some problems with my spinal anatomy. The increased pain, the knowledge that the recovery would be longer and fear that this procedure wouldn't be as strong as the planned one were overwhelming at first. But I trust my surgeon and knew he did his best for me - I did feel sorry for the surgeries waiting behind me that day as my more complicated procedure delayed theirs for several hours:)
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