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ALIF v PLIF - Different Opinions

Jo_vdhJJo_vdh Posts: 27
edited 07/30/2014 - 5:53 PM in Back Surgery and Neck Surgery
Hi All,

For those who have read some of my previous posts, you will know that in the ongoing saga of trying to identify the problems with my back and subsequent nerve damage that I've been given a number of different options and opinons over the time, for those who haven't, the next part will help it all make sense.

I had my original surgery (microdiscectomy) in Jan 2011. Since then in December 2012 I developed a retun of all my nerve symptoms. After now 20 months of this I thought we'd finally come to an end point and had found the correct option to try and resolve my pain. My Pain Management Doc suggested a SCS, but 5 weeks ago my neuro decided that based on the most recent MRI that a fusion was necessary. Great - we have an answer... The Neuro wants to do a ALIF operation and the pain management doc agreed - also great :)

Today I went for a second opinion as I don't think one should have spinal surgery without a second opinion... So I saw a very well respected neuro here in Melbourne - he has previously operated on 2 people I know well and both were very pleased with his level of skill and the surgery results...

The neuro today agrees that I need the surgery, but has instead suggested a PLIF and not 1, but 2 levels L4/5/S1 as the joint at L4/L5 is degenerating because of the stress being caused because of the degeneration of the L5/S1 disc....

He was specifically against the ALIF procedure saying that if/when I need to get L4/5 done it would be more difficult if they did the L5/S1 from the front and that in his opinion they should just do the 2 at the same time.

Clearly no one on here has the medical opinions or enough information to diagnose my issues, but I'm just after some thoughts on what you would do if you had 2 clearly differing opinions on which option to take? Do I go for a 3rd opinion? Do I go with the neuro who my friend and family have been treated by or with the neuro who I saw originally but who I've never heard of anyone having had surgery with?

Any thoughts would be most appreciated.

July 2009 - L1, L3, L5 disc hernation
Jan 2011 - L5/S1 Microdiscectomy
Dec 2012 - return of neural symptoms
June 2014 - fusion recommended - awaiting insurance approval


  • It is hard to know what to do when each specialist recommends differing opinions. I was faced with similar situation where Ortho recommended discectomy and neuro said fusion. I went with the minimum discectomy and ended up with complications requiring another surgery 2 days later and then 7 months later a 3 level 360 degree fusion. You just never know and have to weigh all the options and go for what feels right for you at that time. Best wishes that your surgery goes well, whichever one you go with.
  • pinkfloydpinkfloyd Posts: 70
    edited 07/31/2014 - 1:50 AM
    both are very invasive the advantage of ALIF is the consultant can get better eyes on the spine and can generally mechanically fix the spine with more success .this is strictly from a surgical point of view the disadvantage is the patients will take longer to recover the advantaged of PLIF is less invasive but less able to obtain a good surgical fix as the consultant can only see a small area of the spine .sometimes when the fix is inadequate when only using the anterior method the consultant will use the willet stabilization technique .both ALIF and PLIF are mechanical fixes and both take many months even years to heal there is no guarantee of a reduction in pain with a fusion they are both done to stabilize an otherwise unstable spine .
  • Thanks for your thoughts guys.

    It really is a difficult decision. I've done lots of reading about both procedures and can see pro's and con's to both, as pointed out by KB. The hard bit is, I'm not a specialist in this area, so I am reliant on their expertise to develop and shape my own opinion.

    I think as much as I'd like to have this resolved quickly that I'm going to need to take some time to fully weigh up the pro's and con's of each surgery and work out what is going to be better for me in the long run... I've been dealing with this for 5 years already, and I've only just turned 32 so there's a lot of my life left to consider the consequences of these decisions.

    I'll let you know how I go with my thought process - but if anyone else has thoughts or comments they'd like to share, please do.
    July 2009 - L1, L3, L5 disc hernation
    Jan 2011 - L5/S1 Microdiscectomy
    Dec 2012 - return of neural symptoms
    June 2014 - fusion recommended - awaiting insurance approval
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