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Contiplating TLIF

AnonymousUserAAnonymousUser Posts: 49,321
edited 06/11/2012 - 8:31 AM in Back Surgery and Neck Surgery
I'm new, so please be gentle. In '89 I had my first fusion L4/L5, no hardware. It was so successful that I was on top of the world. No more leg pain (Sciatica), I felt great. About 14 years later I must have done something wrong, probably lifting, and the leg pain came back. I also have DDD, so I'm sure that that played a part. The odd thing about the pain is that it's only there in the morning, but it's excruciating. If I take a 20 minute drive it's usually gone for the remainder of the day and again I feel great. Arthritis? Swelling?

I recently had a CT, MRI and Milogram (talk about barbaric on the last one). These showed lytic spondylolisthesis at L5 upon S1 (bone on bone) and mild spondylosis at L4/L5. I saw a specialist yesterday and he recommended a TLIF. He also said that if I it done that I could also have complications in a few years and have another disc go. This is my biggest worry.

If I stay like I am now, what's the worst that could happen? Would losing weight and physical therapy help that much? He also mentioned injections (not sure what kind), could those help?

I take nothing for the pain except MSM and Glucosamine Sulfate 3 times daily.

I'm on COBRA as far as insurance which runs out at the end of September, so I have to make a decision soon whether to have the surgery or not.

Thanks for any help.


  • Hello and welcome!

    I'm so sorry you are having to again make a decision for or against surgery. I also know how it feels to be losing insurance. As soon as I start working again, I will lose my insurance, so I've had to put a fire under my doctors to get to the bottom of my continued pain.

    Losing weight and PT will most like not hurt, but ultimately your doctor will know what will be best in the long run. Personally, I would try everything short of surgery first, especially if your doctor is recommending it. Have you gotten a second opinion? I wish you the best of luck in your quest, and pray you will find relief!

  • I usually caution against surgery until you have tried all conservative measures. However, with the spondylolisthesis, my feelings are slightly different.

    You can have all the injections in the world and it is not going to change the fact that you have one vertebra sliding over the top of the other. You have instability. Along with DDD, there is not much that is going to hold this in place indefinitely.

    The fact that you only have pain part of the day is probably because the nerve is not yet being badly compressed. This could change in a moment if the slippage continues.

    I would normally suggest getting several opinions. In your case, I would want to know that the TLIF is the best way to go to resolve your problems permanently (as opposed to another type of fusion). There are some new ways of performing fusion -- even since I had mine 16 months ago. I would want to check into this and see if one of the newer methods might be better for you specific problems.... Maybe for that reason, it might be worth waiting a bit if you are not in lots of pain yet.

    Do you need other opinions or are you really happy with your surgeon? Do some research so you can ask your surgeon good questions when you go back to see him.

    It is always a good idea to lose weight, but realistically, in your situation, in pain, how are you going to be able to do this? (short of having your jar wired shut!!) The surgeon is suggesting having steroid injections. These are commonly prescribed as a "conservative treatment" prior to surgery. For some situations they can help with pain, but it will not resolve your spondy. It might buy you a little time, if you are in pain, but it will not help stabilize your spine.

    Please post with further questions and comments. Many of us on the board have had fusions, have had spondy, etc. and are more than happy to share our experiences. Of course we are not medical professionals so can only offer a fellow spiney's perspective. ;)
    xx Gwennie
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  • I agree with you, Gwennie, except on one point: Losing weight. I am proof that it is possible to drop LB's even in pain. I just cut my servings in half, which has led to a 5 lb drop per couple weeks for a month and a half. It takes extreme will power, but it is possible! :D
  • Good for you! But I truly think you are the exception rather than the rule. Most of us don't have that willpower. I didn't mean it was not possible. I just said realistically....Hopefully GYnot has your same determination.

    My surgeon told me that sure, it would be nice if I lost weight...but that it wouldn't really make a difference in my case.

    But obviously, for everyone it is better to be a normal weight or on the slim side, if possible.

    Did you have your CT? Any results yet??
  • Thanks for asking! I have results, but all I can do is guess to the meaning of some of it: "resorptive and sclerotic reactive changes..." I think (hope) it means I'm fusing, although I still have bulging discs in the level above and 3 levels of my neck, but not sure of the other stuff on there :p I'll know more if any of it is problematic on Wed. :W
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  • Welcome to SH :H That is a hard decision to make. I had my TLIF about a year ago and it was for a recurrent disc herniation and retrolisthesis at L4-5, severe DDD at L4-S1, and continuing nerve compression. I had severe pain all hours of the day nonstop, and I decided to go along with my surgeon's recommendation. He did a 2 level fusion with all the instrumentation. Anyway, I think you should really sit down and discuss it with your doctor because of the instability you have. Having a fusion is major and it won't guarantee you pain relief after the problem is fixed. You also have to research about the risks and probabilities of a successful outcome. Like I was told prior to surgery: some get better, some stay the same, and others get worse. It's up to you and your surgeon if this is the best way to go.
  • Thanks all, for the advice and welcomes. I feel so bad for the pain that others are in and couldn't imagine it being all day everyday with no relief. If this were my case I guess I could make up my mind easier and go through with the TLIF. Since I've had the same morning pain from about 2002/2003 and tests that show the same results then and now, as long as I don't do anything stupid can much more change?

    Now that I'm not working and don't have the AM commute I have to force myself to take a morning ride for pain control. Sounds odd, but it's been working for seven years. When I don't take that ride is when my morning and sometimes all day is hell. Has anyone else here experienced this?

    I know I came here looking for advice and appreciate it, but why would I take a chance of making matters possibly worse with the TLIF, putting additional pressure on other discs. That freaks me out. I may just wait. I have about 30 lbs to lose and can recall when the weight was off a few years ago I felt better even in the AM. I know and understand that the current slip won't go back in place with any amount of PT, but if I strengthen up my back and later decide to have the TLIF, chances of success could be that much better. I just don't want to shorten a time frame that my DDD is going to hand me as-is. My Doc says that this could be a result.

    As far as second opinions, this latest is actually the third since 2002 and I like this Doc the most and trust that he knows what he's doing, he comes highly recommended. He's told me about successes and worst case scenarios, yet I overlooked asking him what the successes were in TLIF's for patients that have had previous fusions before and then a TLIF. If I knew that they were just as high I'd take a shot at it. He's out of town for another week, thus my questions here.

    Thanks again for the advice. Don't mind me if I "flip-flop" in the next few weeks. Surgery is still set for July 20th BTW. I guess I'm looking for stats.

    Tony G (aka GYnot)
  • Like you said...if you were in constant pain, you might feel differently. Sounds like you have things under control. Some people have pain for a short time, go to one doctor and are told surgery, and they rush right into it. But that is obviously not your situation.

    Lumbar surgery is almost always considered "elective." The only real emergency is when there is bladder or bowel involvement. If you are comfortable waiting, and you doctor does not feel you would be causing permanent nerve damage, there is no reason to feel you need surgery now.

    In addition to asking the success rate, ask him why he would do a TLIF as opposed to another procedure for fusion. Ask him if he will use a cage, BMP, etc. Find out as much as you can.
  • T is Transforaminal, and I believe A has something to do with Abdominally, correct me if I'm wrong anyone :p
  • Thanks gwennie17. At the time I saw him he mentioned screws. Then a few days later I set the appt, for surgery, with his asst and she mentioned that he was going to do a "lumbar interbody fusion with pedicle screws". Is this and a TLIF one and the same? And what's the "T" and "A" stand for in TLIF and ALIF?

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