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PLIF with Facet Bolts

MarkRMMarkR Posts: 172
edited 06/11/2012 - 7:22 AM in Back Surgery and Neck Surgery
Hi Everyone,

I'm new here. On August 18 I had a single-level PLIF with instrumentation at L5/S1.

I am in my mid-40s. My problems started 19 years ago when I felt a slight twinge in my back when moving greeting card racks. Since then, I have experienced 3-4 flare-ups per year, each lasting 2-4 weeks.

One year ago (August 2007), I suffered another major flare-up on the golf course, but this one never fully subsided like others did in the past. I had tried ice, heat, PT, chiropractor, acupuncture, massage, etc. but nothing worked.

I began seeing doctors in March and the MRI revealed a disc protrusion at L5/S1 displacing a nerve root. I did 3 rounds of ESI's, but they did not help. When I met with my surgeon in July, he noted the disc protrusion but also pointed out how black the disc was on the MRI. It was severely dehydrated and the MRI also showed signs of a partial collapse of the disc space.

My choices were limited to continuing as is, getting a disc replacement, doing a discectomy now and a fusion later, or doing the fusion now. I decided to do the fusion now and get it out of the way.

As a alternative to the typical screws/rods fusion, my surgeon offered to do the fusion with a newer type of hardware called facet bolts (he invented them and they were approved by the FDA in 2006). Facet bolts are screws with a locking bolt fastened on one side. They are put in place through the bones with a sterile, single-use gun.

Using facet bolts allows for a shorter surgery, less blood loss and a quicker recovery. Apparently, there are some anatomical issues that can prevent their use, but facet bolts are being successfully used on 1 and 2-level fusions. It sounds like this approach has been very successful, so far. My surgeon said that in some patients, the bone grafts are eventually growing over the bolts, creating an even stronger fusion.

For my single-level surgery, he was able to use facet bolts. Here is some information related to my surgery and recovery (so far):
  • The surgery took 1.5 hours on a Monday morning
  • Total blood loss was 25cc (really, it was that low)
  • My instrumentation is 2 facet bolts and a rectangular "cage"
  • My graft is bone morphogenic protein
  • Pain was bad until the next morning when they switched me from the morphine pump to Percocet
  • I walked a little bit and sat in a chair for an hour Monday evening
  • By late Tuesday morning I was sitting in the chair again and walking in the hallway
  • I was home late Wednesday afternoon
  • I was able to walk to the mailbox on Thursday - around 90 steps from our front door
  • By the following Monday I was able to walk around 1 mile per day - 2 separate walks of a half mile each
As I write this, 11 days post-op, I am still on the Percocet, but it is at a lower dose (2 in the morning, 2 at bedtime and 1 mid-afternoon). The pain is at a very reasonable level since I had my staples removed yesterday. I am amazingly functional, while still maintaining my spinal precautions - no problems walking or showering, though BMs are still a bit of an issue. Sitting is definitely a problem, though the pain usually comes after I'm done sitting for 30+ minutes.

There is very little information on the internet about Facet Bolts, so I wanted to let everyone know about them as an available alternative. Spinal fusions are tough surgeries no matter what type of instrumentation is used, but I liked the thought of a shorter procedure.

I could be an exception to the rule, but so far have had a very positive experience, much better than anticipated. Facet bolts are relatively new, but if you have to consider a fusion, I definitely recommend talking to your surgeon about them as an alternative to the bulkier rods and screws.



  • Sounds like you are doing great. I had a PLIF on the same date as you. I am not been able to walk quite that far yet. I had some compliations w/ my pain meds which has set me back a bit as I was in excessive pain and breaking ot in rashesall over my body. It seems I', allergic to vicodin and prcoset. I hear you on the BM's, not an easy thing still. I'm sure it will get bettr hen we get off the iron though.
  • I have been off the iron since Thursday. BM's are still as difficult as ever - probably due to the Percocet.

    Things are going well, though I anticipate needing to wear my back brace more often - I only need to wear it when walking (but not for going to the bathroom or kitchen). I'm feeling good enough that I'm scared I will start bending or twisting by accident while lounging on the couch.
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