[Sessy]

Hi All and Ringo- Thank you for your response. It is very helpful and definately not too long.

My husband had an alif surgery several years ago. He has two cages at L5S1 and one cage at L45. These are BAK cages. The one cage at L45 was not stable from the beginning, in fact, after the surgery, the surgeon told him that he had instability and might need another operation posteriorly. He had a large disc space as well and I don't think the cage was tight (large enough) enough to provide stability. I think this is maily whay he did not fuse. On following up with that surgeon though, on imaging, he said everything was ok- good to go and dismissed him after a few months. He did have pain relief for about 3 months after which the original pain returned. The films are not conclusive although a surgeon he saw recently said that he does not think he is fused there. His images do not reveal much. All looks mostly ok. MRI and CTs. As for other reasons whay he may not have fused, after that original surgery, he also had a course of steriods for nerve swelling - I think about a month or two out; I don't remember. But, really, I don't thin the whole thing was stable. He had tall disc spaces and the cages didn't really work for that. I mean they would have had to have been so big to distract the disc space that they would not fit otherwise, they would stick out the side. I don't think they even had large enough cages.

I don't know about L5S1 although it looks to me like one cage is sticking out some laterally from the vertebral body and may be compressing something as well.

This recent surgeon proposed, at L45, a minimally invasive TLIF. He said he would remove the cage by pulverizing it and then would insert another spacer and use BMP. He would then put in rods and screws. One foramen would be opened up at least. My husband has a lot of pain on the right side, so that side would be opened up I think. He would leave L5S1 alone. I am wondering how he will get the cage out. This is a major concern. The surgeon said that he had just recently performed this same surgery on a women and remove a cage this way.

I think that my husband does need a surgery to stablize everything. He is in a great deal of pain and it has gotten even worse (if that is even possible) over the last couple of years. He can't walk farther than around the house and is in constant severe pain. He health is getting worse in other areas too as a result of pain and not being mobile.

The question is: what surgeon to trust? What is the best way to do this? It is so hard. If we knew who was a good surgeon and would be able to accomplish the surgery without complications like nerve damage and so on, it would not be a question. I have to say that after the first surgery, I wonder if they really care about the patient, after all, they make a lot of money and bear no consequence regardless of how the surgery turns out. They can dismiss the patient and then you have to live with the consequences. They just go about their business - on to the next patient. Sorry, but deep down that is what I think and is a fear I have. I think they might think - well he is so screwed up now, if I botch this surgery up, who will know or care? He is screwed anyways.

We do plan on getting another opinion though. It is about one hour drive from where we live and will be very difficult. The limited ability to travel is also limiting the choices of surgeons. We have to be able to get there and my husband does not even think he can do the one hour drive to a Dr. appointment. I am planning on us staying overnight.

Sorry for the longwinded response.

Thank you so much for any and all help and support.

Sessy