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PLIF verses ALIF Recovery

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:29 AM in Back Surgery and Neck Surgery
:H OK Here goes. I've been lurking here for the past few weeks. More frequently since I found out I have to have a L5-S1 fusion :SS . It is scheduled for 30 March 2009.
I see on my "Pre Cert" sheet that I am having a PLIF. The description fits what the Dr told me about what I needed. He just didn't call it a PLIF or ALIF. He just said that I no longer had a disk between L5 and S1 (Diagnosed with DDD in L2-L3, L3-L4, L4-L5 in August 2002) and that he was going to put in a plug, some rods and screws and allow the joint to fuse. He seemed only moderately concerned that I had waited so long to have something done. /:)
I went through PT in 2002 and that was a waste of time X( . I felt that the whole idea was just to see how much money the NS could get for some buddies in PT from my insurance before she would do her part. The experience really left me in a foul and doubtful state of mind about back surgery. :T
I waited until Feb 2009 to get a second MRI and opinion and only then when the pain got so bad I could no longer function. I am very pleased with my new NS =D> . He came highly recommended by my family doc and his nurses. He's on boards in Canada and the US and does fusions for a living. Not just something he CAN do, it's all he does do. My thought is that it's better to have your motorcycle worked on by a bike mechanic than an auto mechanic that works on bikes as a side line. I just hope I haven't waited too long and now have permanent nerve damage.
So, like I said I been lurking around here for awhile and like so many others, I have concerns about pre and post op things. Is it just me or does it seem that PLIF surgeries involve longer hospitol stays and recoveries than ALIF? I understand that we are all different and that no two of us will have the same experience. Is there something different in the two procedures that I have missed that maybe makes the one that much different than the other?
Thanks for reading this and keep on helping others help others.
Tom Veach


  • You need to see if he is planning to do an ALIF/PLIF together. This is commonly called a 360 degree ALIF. They remove the bad disk from the front, place cages and sometimes plates in the front, sew you up, flip you over and attach hardware in your back. I had this procedure done and the hardware was placed using the Sextant minimally invasive system. Either way he does it, recovery takes a while.

    I'm a little suprised that he is only doing a one level (L5-S1) fusion if you have DDD presnt starting at L1. Fusion puts extra strain on the level above and below the fusion site, so therefore if your other areas are already weak, it could lead to further problems. I would speak with your doctor about that.

    Hope this helps!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Pre-Op paperwork only calls it PLIF. NS indicated it would only be an incision in my back. The only time he ever mentioned the front of my spine was when he showed me on a model of the spine what was wrong with mine. That was when he showed me the disk that I don't have much of anymore.
    I asked about the other Herniations and bulges that were in my MRI and he said "One thing at a time. This is what is causing your pain and problem".
    I am comfortable with not doing all at once. I'd personnaly like to make sure that I can fuse at all before he goes slicing and dicing on the rest of my lumbar. With my kind of luck, I'll be lucky to avoid being one of those 5% that doesn't go as planned.
    I've been trying to prepare myself for this for almost seven years and I'm in no hurry to make too big a jump. Maybe I'm wrong but as I said before, this kind of surgery is what this guy does for a living. He even has some kind of award for an invention that he and another invented for doing surgery in the skull using a sonic picture verses a line of site picture. I don't know all the details but you can Google him (Dr. Sumeer Lal) for the details.
    Again thanks for the response.
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  • Hi,

    I had an ALIF on L4/L5 last July and then a PLIF on L3-L5 this past December. The ALIF was a longer hospital stay and harder recovery. I had more issues with my incision than the back incision because of my stomach fat and the fact that I could see it and "bothered" it more. I perioxided it everytime I took a shower and dried it with a hair dryer to make sure it stayed dry. But then I had fluid pop out several times that had collected under the skin. My back incision healed up quicker. I did have lots more muscle spasming with the PLIF than the ALIF. My low back has clamped down hard quite a bit and still does. I have to do a lot of hamstring and other stretching, but I'm very happy with the PLIF w/hardware.
  • Your observation and input is GREATLY appreciated. Not everbody can tell BOTH sides of the story (pun intended).
    My limited research does seem to indicate that most ALIF is for L5-S1 or L5-L4 which fits in with your situation. Not being a surgeon myself I have to trust in my Dr. to make the best decision. He definately seemed more concerned about my L5-S1 sitauation than the others. There must have been something in the MRI that made him decide a PLIF was the way to go. According to the radiologist comments on my MRI
    "L5-S1. Diffuse posterior herniation flattens the anterior surface of the thecal sac, closely approaches the nerve roots in the canal and causes moderate right and moderate to marked left foraminal stenosis"
    That's all Greek to me but between the pictures and the Radiologist comments my NS came up with some good reason for what he's doing and I trust him.
    My un-educated guess is that because there is foraminal stenosis on both side, he has decided that the foramin must go anyway along with what is remaining of the disk to releave as much pressure as he can in one shot.
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