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ALIF W/O steel frontal plate OR posterior screws...HELP

virginiapvvirginiap Posts: 508
edited 06/11/2012 - 7:47 AM in Back Surgery and Neck Surgery
just back from 20 day post op with NS, I am confused! Doc said would do full front procedure with NO NEED for posterior augmentation (screws) as he would use a plate. (in front/ in top of hardware, to hold all together) Today we reviewed post op films and he explained he actually used a wedge?? And PEEK cage, which originally was to have been a titanium cage, he always said there would be 3-4 screws - he used 3. He had also said there would be a rod, not even sure, if there is one since he opted not to use plate. Ok, I am all for less hardware! If it safe and will hold.
He said today he used as big of a wedge/cage as possible to reduce and relieve foramanal stenosis. Here is my HUGE & SCARY problem, many other NS & spinal surgeons I have consulted told me even with use of a plate you may have issues with maintaining fusion. One NS even told me he knew of no one who can do an ALIF, without 360; to balance and ensure hardware placement. Now, I am sort of well versed on this subject, most of you are 100% more astute, then I with all of your forced gained knowledge, haven had gone through your surgeries and or treatments. My fear is my doc has attempted something on me not widely practiced. BTY, My NS is EXTREMELY gifted, brilliant & talented. Which is why I chose him, even though every other consult said 100% PLIF.
I knew going in doc said there would be scores of options as far as hardware goes, as once he is in there, he will make the call on what to use.
I had a fantastically talented vascular surgeon do approach & close.
Should I be nervous,worried or even concernd??
I have no improvement in leg tingling and numbness. My belly is a mess, pain, bloated, incision pressure, nausea, unable to poop (sorry)can't stop peeing, have a deep seated hematoma, which neither,PCP, NS, Vascular are concerned with, all say will resolve over 6-10 weeks. Also, seeing I'm spilling my guts, also had bone graft taken from illac crest, Ouch. No external stitches! Vascular doc did great job the bone graft area is about 2 inches, steri steps just came off yesterday, on my surgery site about 5 inches, they look like they were just placed! Doc said let them stay on till the come off on own, anyone else have steri strips still 3 weeks post op?
I Know I drafted a novel here sorry PLEASE, THOUGHTS INSIGHTS, OPINIONS!
Ps my next topic will be my meds... so many pills still suffering...next post.. this wore me out.
Many thanks!
Healthy & happy wishes to all!



  • I had an ALIF 11 months ago and today I'm fine. I can't say whether you should be concerned about your ALIF, but I can say how I've been going.

    My neurosurgeon believes that an anterior fusion is a very good operation and has had a lot of success with this procedure. A year ago, he'd done over 250 of them.

    To relieve the pain from the spondylolisthesis, my NS put a larger than normal cage in to jack up the space between the vertebrae. My understanding of the hardware is that there is a plate with two long screws. He used BMP for the graft.

    I fused within 6 months and since the surgery, I haven't had any major leg pain from L4-5. For a few months, I was getting leg pain from the levels either side of the fusion, but that settled down. I had leg pain from these levels pre-op. I was given Gabapentin (for the nerve pain)for a couple of months post-op, as well as Oxycodone and Oxycontin.

    My tummy was sore and swollen for several months. I didn't have any constipation pain, perhaps because I had to do a bowel cleanse the day before surgery, however, they had to do an enema prior to leaving the hospital. Since then I eat about 10 prunes every day as well as plenty of fibre. Medication does make you constipated. Would encourage you to drink as much water as you can tolerate and if you need to take laxatives, find one that doesn't give you stomach gripes.

    The tummy does take a while to settle down because the surgeons have had to put a large circular retractor to open up the abdomen and then the organs are pushed out of the way, and I guess they get very "angry" and let you know all about it. Well, that's what they did with me.

    I had dissolving stitches and my scar is so fine and can hardly be seen. I used Bio-oil for several months to keep the skin soft and flexible. However, the scar looked pretty ugly for a couple of months.

    I had a haematoma after surgery which showed up on the scans. I had one of those dreadful spinal headaches for a day, but I was fine after that.

    My surgeon said I had a good strong fusion at the 6 month appointment, and that level of my back feels very stable now.

    The neurosurgeon that I went with was the third one that I saw, and one of the others said that he was going to do the fusion in two parts, but didn't call it a 360, but I'm thinking that was what he meant.

    During the long recovery period, I observed the bending-lifting-twisting restrictions and had a domestic service come in once a week to clean the house. This was my one opportunity to get well and so I didn't do anything that I thought might affect the fusion for several months. I did heaps of walking, initially in smaller amounts, and the stretching and mobility exercises that I was given in the hospital.

    Recovery is a tedious time, but I'm sure you'll do well by following your surgeon's instructions.

    Hang in there, and rest and walk in small amounts as much as you can.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • Thank you Trish for taking the time to read my long post!

    My NS also used a very large cage and this wide wedge to jack up disc space, as he felt this would relieve the stenosis and restore the collapsed disc space. (not even sure what a wedge is, but it is triangler shaped and was placed in the most posterior part he could access). Seeing I have two other levels that are suffering loss of height as well, he felt it necessary to get as much height as possible, which is one of the reasons he wanted to do the ALIF approach, he said with a posterior approach there would be no way to place a tall/big enough cage that my situation called for. My NS has the most ALIF’s under his belt in the state of Florida. So obviously I felt confident with him doing this approach. Plus the vascular guy was amasing, I had the dream team!

    Along with my own bone graft, he did use BMP in the PEEK cage.
    I am happy to hear of your fast fusion rate and that your leg pain has eased up, that is fantastic! My leg pain has not eased up yet, in fact, I think it is worse. Doc said, it takes some time for things to adjust to new alignment.

    I have not been given anything for nerve pain yet. One neurologist (who did my EMG) had given me a script for restless leg syndrome, which I never filled.dont thing thats my issue.

    As far as meds go, (post op) I was on Oxycotin 20 2x per day with Oxycodone 15 as needed for breakthrough, also, xanax, valium and soma, and taking phenegran for nausea, which has been an issue. like you said angry organs!

    Since seeing my new Pain Mgmt, he changed up my oxy. Took me off Oxycotin as it really was not working, It really did not help, I was in pain within an hour or two and then was taking the oxycodone too often. I am now on Oxycodone 30 every 4 hrs along with all the others and he added restiril to help me sleep, which has been impossible with my pain levels. The new oxy levels are much better for me the extended relieve was just not doing it. So now I am getting 180 mg per day oxycodone and it helps. all immediate relief, I guess, I am an immediate relief kind of girl!

    Belly swelling has been an issue, especially for me, I am little 105 pounds. Plus the hematoma, I look disfigured! My hematoma is very visible, even though it is deep seated. Oh well, least of my worries! My NS has granted permission for Magnesium Citrate, but I have to first get approval from the Vascular surgeon… (that call is for tomorrow wish me luck, he calls it draino!) seeing last week he forbid it. I am taking about 10-20 Metamucil pills per day…. And not much help in bowel movement department. Dringing prune juice like crazy and eating plenty of fruits and veggies.

    I am in a big strong ridgid brace except for sleep & shower, NO bending, lifting or twisting, not that I think I could do any of those if I wanted!
    My husband is home with me night and day and has been doing all the cooking, cleaning, shopping and driving me from appointment to appointment. Thank god for him. Though I feel bad for the burden, I don’t think I will or can make it without his help.

    NS has ordered PT starting next week, three times per week, per work orders stretching and endurance….. not sure what if any of it I can do. I have been walking with the walker but for no long length of time. 5-10 min max and then too much pain to continue.

    I am just so worried about not having the plate, or the posterior screws, I don’t understand how this is all going to hold. I did some research online and nowhere does it indicate ALIF without one or the other…. Again, I am worried. My concerns were not fullly addressed on my first postop by NS, but next visit is 10/11 so I will bring up again, this time, I think I was just shocked.

    Thank you again and best of luck to you in your continued recovery.

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  • Hi Virginia

    Your husband sounds wonderful. I'm sure he doesn't feel that you're a burden, and you'd do the same for him !!

    Even though I wrote down my concerns when I had appointments with the neurosurgeon, very often the discussion goes in a different direction to what I'd planned, and then I forgot to ask what I wanted to.

    Are you able to contact your NS before you start physio? It's still nearly a month before you see him again and because you're worried about not having a plate, it would be good to get reassurance from him.

    You're starting physio much earlier than me and I'd encourage you to go very gently with it. It's very important to stretch and maintain flexibility. My physio specialises in sports rehabilitation, and so I had to let him know that I needed to go very gently with the exercises. It was hard work but an essential part to my recovery.

    5-10 minutes with the walker is fine. I've read that walking helps with the fusing process. In the early days, I needed to do lots of small walks, even during the night because the leg wouldn't settle down.

    It could be worth filling the script for the restless leg syndrome or asking your pain management doctor for Neurontin or Lyrica. Lyrica made me feel awful and Neurontin was better for me. Some others here have had the opposite response.

    It's good that your doctor has sorted out the oxy level and it's helping your pain.

    Good luck with the magnesium citrate !!


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
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