How has your ALIF surgery worked out?

[speckopolis]

I had TLIF surgery 11 1/2 months ago, and "fired" my doc last week. The new doc says that I might not be fused from that surgery, and if not, I will posibly need an ALIF. My question is... If you have had the surgery, has it worked for you? Would you do it again? What were some of the worst parts of recovery...? Etc...

[speckopolis]

Thanks for posting. We are doing a myelogram, mri with contrast, and EMG test this week. My most recent CT scan shows the following. Are the bulges necessarily going to be a problem? Or could they resolve on their own. Is the stenosis something that you think needs to be resolved? I know you can't really diagnose over the internet, but just wondering what your thoughts are on this:

T12-L1 Minimal disc bulge. No significant stenosis.
L1-L2 Very minimal disc bulge. No significant stenosis.
L2-L3 Moderate diffuse disc bulge with deformity of the thecal sac. Borderline central stenosis. No foraminal stenosis.
L3-L4 Moderate diffuse disc bulge. Superimposed central disc protrusion with deformity of the thecal sac and moderate central stenosis. Foramen are narrow, right more than left. There are some osteophyte formation and disc lateral on the right. extraforaminal with impingement of the right L3 root. No significant impingement of the left L3 root.
L4 bilateral screws. Screw on the left traverses the left pedicle, however, the screw on the right is situated lateral to the right pedicle. Tip is within the vertebral body. Osteophytes and bony spurring are present laterally and superiorly at the vertebral body and superior endplate. Tip of the right screw extends to very near the superior endplate of L4.
L4-L5 There has been resection of the inferior left L4 facet. Graft is in place at the disc space. Graft extends posterior and the lateral slightly beyond the margin of the vertebral body. There is additional bony spurring at the left lateral recess and proximal foramen. Tere appears to be probably mild/moderate central stenosis and lateral recess stenosis. The left foramen is narrow inferiorly. There may be impingement of the left L4 nerve root. The right foramen shows no stenosis or impingement of the right L4.

There are bilateral pedicle screws at L5 which appear to be in satisfactory position.

At L5-S1 there are some degenerative facet changes, left more than right. Mild diffuse disc bulge is present. No significant central stenosis. There is left foraminal stenosis from facet hypertrophy with mild to moderate impingement of te left L5 root. The right foramen shows no significant stenosis or significant impingement of te right L5 root.

Impression: Disc bulges and protrusions at multiple levels. Surgical changes at L4 and L5. Hardware position as described. Nerve root impingement at multiple levels as listed.

[Dr Sharma]

Dear Speckopolis, welcome to the medhelp forum. TLIF or spinal fusion is undertaken to reduce pain and nerve irritation by stabilizing spinal vertebrae and the disc between the vertebra. This TLIF or transforaminal lumbar interbody fusion technique is preferred since it offers better spinal stabilization. The anterior portion is stabilized with the bone graft and interbody spacer and posteriorly with pedicle screws, rods and bone graft. The possible complications are of nerve injury, lack of solid fusion and persisting or worse pain. The anterior approach or ALIF may have high non union rates since you have had a prior back surgery or if the fusion involved multiple spinal levels. If you have had a non union, you don’t require another back surgery if the joint is stable and symptoms are better. Discuss with your neurosurgeon how he speculates the situation and anticipated prognosis with another surgery. Wishing you all the best.