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Considering 2 Level ALIF

hi there,

i'm posting this just to get some opinions from people that may have been through the same. I know im the only person who can make this decision, but im just interested in hearing the opinions of people who have been through simialr and their result, and a few questions.

im currently 41

** brief history

injured back in fall on concrete about 15 years ago

ct/myleogram showed probelms at l4/l5 l5/s1

had open discectomy at l4/l5 after year of pain and chiro, pt etc etc

helped a lot but still had ongoing issues

about 2 years ago l5/s1 went

open discectomy at l5/s1 (herniation) and l4/l5 (remove scar tissues that had bled over from first op - looked like an extrusion on mdi but was scar tissue).

** now

on mri recurrent/remnant (?) 7mm herniation at same l5/s1 site.

frequent discomfort, nerve pain in toes n calf on side of last discectomy. very limited in what i can do without aggravating it - i can walk, sitting is difficult, walking too far aggravates it, a car drive into the city is an epic ordeal (if not during it, the next day etc). life in general is difficult (more so than normal:))

while i know its not as painful as before the discectomies, i feel very limited.

very little sex inclination due to general soreness in the area (much to the chagrin of girlfriend - not entirely sure why she hangs around, shes quite a girl).

in short its really limiting my life and I cant push myself in anything physical at all. my 65 year old mum carries the groceries in as ill be suffering either then or the next day.

after 15 years of back problems , im pretty much over it. ive been to some dark places in my mind, get moody quickly. my job options are very limited ( i certainly cant sit at a desk all day in a tech IT job - which was my degree), cant sit in a car commutting for 1.5 hrs to the city etc.

** future
ive put my current mri on my profile pic, but my surgeon is recommending a 2 level ALIF and im considering it but am wary.

he said *no more surgeries from the rear* as they are too destructive and scar tissue can be a big issue (as i found).

he feels im not eligible for ADR because of previous discectomies and facet joint condition.

some things about the alif that scare me (well all of it really) but some specific things -

* retrograde ejaculation - im told this is rare but if it is a result - does it hurt? what is the mental impact of this?

* can you feel the titanium plates etc inside you?

i sweat just thinking of the catheter again (ha) but would like to hear peoples opinions.


1994 - herniated disc l4/l5 l5/s1 - sciatica - l4/l5 discectomy
2011 - l4/l5/ l5/s1 herniated disc/scar tissue - sciatica - discectomy
now - recurrent disc protrusion l5/s1, lots of back pain, considering fusion/adr



  • From my own experience, I'd say an ALIF is the way to go if you HAVE to have a fusion. I had the PLIF first, which failed, and at the redo there was a lot of scar tissue that needed to be removed.

    Having said that and 18 months after this successful ALIF I sort of wish I had never opted for surgery in the first place. I thought that as there was clearly a mechanical and anatomical issue that could be fixed with surgery I would be cured. It just isn't true and I do wonder if I'd stuck it for another two years doing PT and perhaps the injections whether I wouldn't have been the same or perhaps even better.

    Oh, and I have screws and rods at the back too. Them I can feel through the skin, but nothing from the front hardware.
  • sorry if you don't like it but i wont sugar coat it !
    after 16 years of back pain and 2 previous spinal operation ..i had no choice as my back was unstable a fusion was the only option .so i found a reputable consultant {probably the best in the uk} then had to wait a year as his list was so long and i was classed as urgent .anyway day one the operation ..after being put to sleep i remembered nothing but on waking i was in a massive amount of pain and could not believe what i had done .[apparently this is a common thing}.i was given massive amounts of drugs to control the pain and spent the night ..not in HDU or IT U but in the theater recover unit as i was too ill to go to any other place ..they could always put me back to sleep and operator if needed .and i had my own little team with me a pain nurse and theater technician and an anaesthetist the pain nurse stayed with me all night and was fantastic ,day two still in pain but able to be moved to the spinal unit .i was left on my own for the first time and that was scary there i was in bed comfortable and catheterised {yuk} i was allowed visitors for the first time i was off my food as my throat was scratched during intubation and i could only talk a few words then my voice would go i was in a sorry state .as the week progressed the catheter was removed and i was on my feet i passed the physiotherapy test and after my bloods settle down i was allowed home {a week later} when i returned home i was so happy to get on my recliner {if you done have one get one now a rise and recline type so you can sleep on it if needed and it will help you stand up .also a raised loo seat a safety rail in your shower and a grabber you must have a grabber they cost around 10 pounds and amazon is about the best for choice .there is a good list of post op must have {worth a luck}.its been 9 months now and i am still in pain and i have leg and foot problems not there before the operation .good luck with the ALIF is not an easy operation to recover from forget what you read about returning to work in 6 weeks [at the 6 weeks stage i was still sat on my recliner zombied from all the drugs and stress of the op }you will need at least one year to recover my consultant has told me in my case i will need two to three years ..good luck my thoughts are with you
    tony {UK}
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • rocker2000rrocker2000 Posts: 15
    edited 10/19/2012 - 1:14 PM
    thanks for the stories everyone, if there's one thing i know, there's no sugar coating this injury, its pain or its treatments :) id prefer to have broken ten bones rather than these discs :)

    re: physio, prior to the first surgery i waited a year in pain and spent a lot of money on physio, mckenzie, chiro, massage, trigger points therapy, acupuncture and nothing worked. my understanding is the discs have no blood supply/nervation and never heal ( a doozy of an injury).

    i should add as well, for my current dilemna ive seen 3 specialists for opinions ..

    #1 (who did the last discectomy) said, despite the pain and limitation, your nerves are working. he basically said the next step for him would be a posterior fusion, but basically said it could make it worse so just live with the current situation (easier said than done, but i understand where hes coming from). he doesnt do alifs and didnt say why.

    #2 just leave it, in 5 years it *might* improve enough on its own. thats a long time with no guarantee of improvement, but i understand his view. if anything he would carve out more space at the back (didnt like fusions or ADRs , said revisions to ADRs if probelms were a life threatening situation). he doesnt do alias and didnt say why. i think they were both older specialists who do posterior style fusions.

    #3 said it was treatable by ALIF and the fate of discs is already sealed and will get worse. Said no more rear surgeries as they are too destructive and some disc probelms eg large contained protrusions are not really good candidates for discectomy in the first place. I wondered if he was just "surgery happy" but he said he wouldnt take my money prior even if i had it in savings and wanted me to wait til i had health cover. he is also well known around here for helping a few people out and taking no fee (which is something rare from what ive seen in a couple of newspaper articles).

    1994 - herniated disc l4/l5 l5/s1 - sciatica - l4/l5 discectomy
    2011 - l4/l5/ l5/s1 herniated disc/scar tissue - sciatica - discectomy
    now - recurrent disc protrusion l5/s1, lots of back pain, considering fusion/adr

  • aware that a whole lot of things need to be moved and cut out of the way. You need to find a vascular surgeon to do the work as a lot of what has to be cut and moved out of the way is vascular in nature. You want a surgeon that does this a lot, the vascular part, and you most likely will have no problems. It is a red flag to me if a orthro or neuro says they will do this themselves which I have heard happening. Unless they have another doctorate degree in vascular surgery I would run and run fast. Ask to be shown what all needs to be moved and cut to get to the front of the spine and you will see what I mean. It takes a vascular surgeon about 45 minutes work just to get to the spine and that much time or more to close you up.

    Complications are rare if you get someone that does this often. I'll get off my soapbox on that. I have had it done 2 times and have not had any problem at least none I'm aware of as I'm still healing. Some people have a lot of pain, swelling and soreness from this type of operation but I didn't have any, well some pain is expected from the surgical part of it.

    Good luck.
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