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ALIF with no instrumentation?

heidihohheidiho Posts: 17
edited 06/11/2012 - 7:27 AM in Back Surgery and Neck Surgery
OK, does this sounds strange? I'm having ALIF on L5-S1 with NO instrumentation (only cage). It's almost impossible to find someone else who has had it done this way. Also, he is using only BMP, no autograft. He said he has done 12 this 'new' way and all had great results.

I'm afraid of feeling very vulnerable without any screws/plates, etc.



  • But anytime I hear of a fusion with no hardware, it makes me nervous. Have you gotten a 2nd opinion? I'm just 1 week out from my ALIF w/ front plate & screws, my movements are not perfect but I take comfort in the fact that there is a little titanium plate holding it all together.

    BMP as standalone - have also not heard of this, but see what others say, BMP is a hot topic around here. :O

    Jan 2009 L5-S1 ALIF
    May 2017 ALIF L4-L5 with PLF rods added L4-L5-S1
  • One of my levels was slow to fuse and I had a dynamic system supposting me for a while, which wasn't enough and had rods put in later.

    Go for a second opinion. Your first surgeon shouldn't mind you being thorough....especially if he is so confident with his outcomes.

    Good Luck.
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  • Oh, I would love to go for a second opinion....this guy is the most highly regarded in my neck of the woods AND it took 12 months to get an appt. I AM IN CANADA! Whole different scene here.
  • I had ALIF with no instumentation, just a cage, at L5/S1, along with ADR at L3/L4 and L4/L5 in April last year.Seems it is not that unusual here in the UK?
  • Thanks Brian. Wow. So you are happy with your surgery? Why did they not do ADR on the L5/S1?

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  • I' not entirely happy - no, as I am still in pain. I had two conditions - Spina Bifida Occult and Sacrilized Transverse Process (Bertolotti Syndrome) which together have caused the original damage resulting in the hybrid surgery. The decision to fuse L5/S1 was to "finish what nature started", ie fuse the whole lot. Fusion at that level does not reduce mobility very much at all - if any, so was reasonably happy with the decision. I'm still having a lot of pain which points to the sacrilized transverse process as the cause and may have to have more surgery to release it.I'd like to find someone who has had this procedure to ask about recovery times, but so far, no luck. I certainly don't want to go through anything like the last surgery again if I can avoid it!
  • i had BMP only, no auto or allograft.

    there are actually a decent amount of people i've heard of without any instrumentation. the cage is pretty durable, and the pressure from the rest of the spine generally holds it in place.

    the good thing about not having hardware is that you aren't running the risk of hardware issues in the future. most people don't need theirs removed, but it does happen.

    the thing about rods and screws with an ALIF is they'd have to open your back, too. so that's a whole separate area to heal.

    if the doctor has a good reputation and satisfaction rates, then i wouldn't be too worried. what you're having done is not uncommon, and these days BMP is becoming the standard.
  • Hi, My ALIF was on L4/L5 this past July and I had only cages and BMP. Turns out the BMP hasn't done a thing and one of my cages moved and pressed into my spinal cord. I had PLIF in December to add screws and while he was in there thru my back found that my L3/L4 facet joints were just about gone so that level was jiggly and loose. He put screws in there to. Since the revision surgery, my back has felt "right" and tight. I'm still having soreness and stiffness and just returned to work this week. The pain before and after the first surgery was horrible.

    I have a friend that had L5/S1 done with cages only and BMP and she started fusing within 2 months.

    So some folks have great luck with cages and BMP and no screws and the L5/S1 level is not has torqued during movement as the L4/L5 level. The PLIF hardware is harder due to having so many more spasms and muscle problems than the ALIF approach.

    Good luck and hope you get relief.

    You will probably do just fine and not have any problems.
  • I am a 48 year old male and had my L5-S1 fused with cages only on Feb 28 2008. I went in for my 3 month checkup and the fusion was looking good. My surgeon said that after 6-8 more weeks I could start my rehab. I have started going back to the gym every other day and feeling pretty good for the most part. I did "tweak" my back a little bit the other day and I am having some numbness in my left leg. My surgeon said that it is very common to have symptoms similar to the ones I had before the surgery.
    I am an avid golfer and have also begun to hit balls at the range.
    I go back to the surgeon again in late April for another X-ray to see how the fusion is progressing.
    I have a message in to my surgeon to see if this latest pain and numbness is anything to be concerned with.
    I will post again when I get an answer.
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