Help/advice needed re TLIF/PLIP back operation

[Cool B]

Hi everyone I am new to the forum and this is my first post.

I have had scoliosis and disc L4/L5 disc problems since the age of 19.

In November last year I had a discetomy on L4/L5 and it was totally sucessfull no pain at all for 5 months than bang in April this year the pain came back much worse than before so much so that I am now on a raft of medications.

My consultant having seen my latest MRI wants me to have either the TLIF (transforaminal lumbar inmassageplanetody fusion or the PLIF postero-lateral instrumented fusion. I am terrified and he has given me 6 months to make my mind up about this op. Trouble is been on the internet to find out information about these operations etc but its hard to find anything which is not based in USA i.e. patient stories of these operations and what to expect before/during/after the operation etc.

This is why I have decided to become a member and post because I know this site was a god send for me before and after my discetomy operation.

 

[strata]

Sorry Mel, I didn't see your post till now.

Fusion is the very, very, very last option ever!! Only after you have run out out of all other options do you even think about it.

The reason you can't find information is because the fusion equipment manufactures and their sponsered Surgeons don't want you to find any.

Although modern versions are better, it is still the most destructive procedure and offers clinical outcomes as low as 20% for 3 years and over. Repeat operations are common place!

I read an article from the states which said that when a government health inspection body wanted to run Randomised Control Trials and clinical outcome inspections on Fusion procedures the Companies and their sponsered Surgeons went to Congress and pulled the funding for the entire insection team and closed them down.
Fusion is big bussiness and patient satisfaction is not the priority!

If I can find the article, I will post it, its an eye opener!

The NHS in Cardiff have never carried out any RCT's of fusion and decompression, yet it is carried out every day!!

Do Your research on minimally invasive endoscopic spinal surgery as this will offer the best clinical outcome for you and will reduce the unnessasary destruction you face with fusion.

Best wishes


SPINELF

 

[coiodkxi]

Thank you so very much SPINELF and sorry I have not replied sooner but I gave up hope of anyone replying to my thread. It was so kind of you to reply and the information you gave me very helpfull I will go and take a look at minimally invasive endoscopic spinal surgery as you suggested.

My gut feeling is to not have this operation and after talking to my G.P. who told me even after 6 months to not feel under pressure to have this operation as if my back gets really bad in the furture I can always revisit having it done. The strange thing is I have not heard anything good about fusion surgery so I think i pretty much made up my mind not to have it done. Thank you so much again for your kindness in taking the time to reply with great information best wishes to you Melanie

 

[n2010]

Thank you for kind words Mel, it was no problem at all, we are all hear for you, any time!

Its great that you did your research and arrived at a well thought out decision that you feel is right for you, well done!
Me & Cassie are proud of you!

Have look at these sites for your research Mel:

www.bonati.com
www.laserspineinstitute.com
www.microspine.com
www.spinal-foundation.org

let us know what you think?

Best wishes

SPINELF

 

[roderick_young]

Hi Mel_kim,

I am awaiting my seconed spinal surgery (ALIF). I was just woundering did you go ahead with your surgery or not. in your last posting you had opted not to have it done.

I have been suffering with back problems for over 10 years and I have decided to go for it (fusion, ALIF). If the pain is so bad and life becomes so worthless, you would try anything.

Any feedback would be most welcomed.

 

[Shalom]

I was offered ALIF last week and when I questioned the surgeon about why he thought it was the only option he was a bit stunned when I explained the MISS approach to him and said that was what I wanted and not 6 -8 screws and bolts with rods with the prospect of more surgey later as the next level gives way under the stress... to which he proudly said we can add as many bolts and screws to fix that too all the way to the top! Totally ignoring the alternative treatments via endoscope. After a lengthy discussion he agreed to refer me to an endoscopic surgeon.

MISS is the way to go, we need more MKs! Most other countries use it now including many that the UK might think are not as cutting edge as us The UK needs to catch up and stop using barbaric methods to treat backs.

 

[Santa In Your Panties]

Hi Guys

MISS is not always the answer to your problems. It has its drawbacks as you may need more than one attempt to sort out the problem, as in my case.

Also, fusion should be seen as a very last resort (in my opinion). I have had ADR (artificial disc replacement) surgery at two levels which should be a solution to the problems I have been suffering. Still early days yet, but people shouldn't get hung up on what is 'right' and 'wrong'.

In the early days of my problem a discectomy allowed me to carry on with my life, until the degeneration grew worse.

I don't think it is fair to try to make people believe that some procedures are ultimately 'butchering' because they aren't.

We should be supporting people who are thinking about surgery, or waiting for it, not frightening them away from it.

Maz

 

[thoushaltcountto3]

Fusion can also be done with minimally-invasive approach.



Unfortunately, traditional methods are still mostly used, but they indeed are "butchering" and too big percentage of people with this surgery end up in problems.

 

[Kami y]

Thats not entirely correct is it? If the problem is a only one level or at least only one side then it can easily be carried out in one Endoscopic MISS operation. However, if it requires both sides to be accessed then, yes, that is two operations. Attempt is the wrong word, because I am sure that if an 'attempt' failed then another 'attempt' would be made rather than one operation being a success but another disc prolapse still causing pain and so needing another operation?

I want to understand this, so please try and see what I am saying here?

 

[Gep]

Can it really? Please tell me more as most seem to go in gung-ho cutting 6-10 inches and cutting off bone then scraping muscle away from bone and quote one of my prospective surgeons " we hav to destroy so ve can fix!"

 

[Luann]

The question as put seems to ask - operation or not? - which is a bit polarised, and missing out on many other questions. Top of the list should be 'what other ways are there to approach this problem?'.

I'm used to this kind of advice falling on deaf ears in the spine surgery section. Strange that, I have no idea why that should be, but hence I usually don't post here very much anymore.

I echo Mad_Maz' sentiment, that fusion is a last resort, but I'd take it further, and say that surgery should be last resort.

However, you have six months to get some relief another way, I suppose. How about finding out if the scoliosis or some of the associated factors can be relieved - thus perhaps taking pressure off the strained areas? You may have been told not, I would say don't keep asking those who say it can't be done, but try and track down somebody already doing it.

 

[Janet712inEngland]

Yes, it is possible. Advantage of this procedure is less tissue and muscle damage, reduced chance of nerve damage, less bleeding, much quicker recovery...

I am sure there are a lot of ways of doing this, but I think most spread technique is tubular retractor assisted discectomy (aka METRx) and then percutaneous transpedicular screws and rods with other system (SEXTANT).

 

[Sam Manhatan]

Statement that surgery should be the last resort depends only on patient, his symptoms, imaging and the fact if his condition reduces his normal daily activities.

 

[$$$]

Is any of this available on the nhs or private. In either cases would you please tell me where and who should I go to see. I am willing to go to the ends of the earth to be in the right hands. My first surgery, 4 years ago, was a disaster and I am terrified of a seconed one, unless I feel I am in trusted hands and a sugeon with proven track record.

Also, is the ALIF procedure applicable to these techniques ?

My problem is that, in addition to my DDD in the L5/S1 disc, I have developed a degeneration in my facet joints at this level due to failure of the first operation (non instrumented posterior fusion), the surgeon did not remove the disc. I have been told that ADR would not be an option for me now since the facet have been compromised.

I have absolutely no life quality and I have tried everythink from physio, chiro, accupuncture and you name it. The only benefit I got, if any, is temporary and the flare-ups retunrs as soon as you move a little bit out of the norm or else I wake-up in the morning having slept on the wrong side !

Thank you for all of the valuable information posted.

 

[PDJoseph]

Hello,

sorry, I am not from UK so I can't help you about the doctors and technology availability...

ALIF can be done with some other MISS techniques, but not with METRx and SEXTANT as it is done anteriorly (trough your stomach).

For L5-S1 disc, if you are a candidate for spinal fusion, you should explore possibility of trans-sacral fusion (surf about Trans1 AxiaLIF). It is minimally-invasive fusion method. Quote: "Using AxiaLIF, the lumbar spine is accessed through a minimally invasive opening adjacent to the sacral bone."

But for example TLIF is not a disaster surgery there is a good indication and patient selection. Two of my friends had fusion recently (one PLIF, one TLIF) and they are booth doing great and getting better and better every month).

 

[Karen Young]

Like Mel_Kim did initially after discectomy. I want to know what this is like in ten, 20 and 30 years' time.

 

[BADNESS]

Around 30% of people with traditional discectomy end up in problems. Maybe situation would be different if she had minimally-invasive treatment at the time? This is rhetorical question.

 

[_shady_]

Sure it's rhetorical, but it's an important issue. Long term outcomes are very important too, surgical changes are difficult to reverse and may have implications for future health and other approaches to change.

Hence as per Ashfar ruling on informed consent:

complete risk profile
remote but possible risks
need/indications
expected benefit and likelihood of benefit
prognosis without intervention

are all pertinent and should be covered in all discussions with prospective patients, and with reference to the evidence base.

I would add that consideration of alternative interventions and other options should be made on an impartial basis, and statements such as 'this is the best intervention', 'there is no other way', should be avoided.

I'd say Mel_Kim has a lot of questions still to ask.

 

[No can do Obama!]

Dear keano,


I searched and was amazed, thats so much better! Do you know if they can do S1/L5/L4 or even to L3? or is it limited to one level fusion because of the miss?

 

[Lubyloo]

It can be performed as two level procedure L5-S1 and L4-L5... But not only L4-L5.