Xlif

[pcrane1126]

Has anyone had an xlif to repair an L345 fusion with screws and bars that didn't completly work please let me know?

I am being told by one doctor that I am a canidate for his procedure of an xlif. I had L3,4,5 done in 2009. L45 the fusion is nom exsistent and need to be redone 3.4 is fused but the xlif surgeon said it is only 5% fused and if he goes forward he would re do L3,4,5. The problem I have is I have 6 screws 2 cages 2 bars in place from the previous sergury. How does he get in from the side with out removing the stuff and still have enough room to get the old cages out and new ones in?? He believes it is no problem becuase of the height of my hips he can do it.

I was seen by my original surgeon and when I asked him about an xlif he with out hesitation said he didn't bring it up becuase he didn't feel I was a canidate becuase it was a do over not his words mine.

I got the 2 of them to talk and from what I understand they had the same opinion when speaking to each other and it apparently got heated. So I am left to figure out what is best .

I had also been seen by a spinal surgeon from NY Prespeterian hospital who didn't mention the posibility of the xlif procedure either. He did mention going from the front or even possibly going throughthe back to clean things up and if it could be done go ahead and if not then do the front approach but never mentioned the side approach or xlif.

I am skeptical. It sounds great same day surgery no hospital stay a lot less pain and recovery time.

Normal recovery 6 months 2,3days in hospital ???

What to do??

[mmglobal]

PCrane... welcome to the forum! Sorry you find yourself needing revision surgery.

Using the terms from your post, is the 'original surgeon' highly experienced with XLIF? (how many?)

Is the surgeon who wants to do an XLIF something of an XLIF wizard? (Again, how many?)

Surgery is a compromise. XLIF is great, but as most less invasive approaches are... it is a compromise. How well can they see? How effectively can they use thier tools? Can they reach everything they need to? They certainly can't access as much with an XLIF as they can with an ALIF. (Open anterior approach.) Are the compromises relevant to your case?

I'd certainly ask the guy who wants to use XLIF for the revision, not only how experienced is he with XLIF, but how experienced is he with 2-level XLIF in a partial union kind of revision?

This is a tough call and you are going to have to make the decision and live with the results.

Are you a smoker? If so... quit! Your life depends on the fusion. Will the surgeon use BMP? What are the trade-offs with BMP (risks versus greater chance of fusion), and how are they changed with the revision you need? I would think there would be a higher risk tolerance in the revision surgery... with one non-union already.

Is Fabien Bitan one of the surgeons? If not, is he an option for you? Fabien Bitan, M.D. - Home

Let us know how your decision making process goes. Contact me via the GPN website linked below if you want to talk.

Mark

[dshobbies]

Hi PCrane and welcome to the forum,

I'm so sorry your two level fusion did not fuse and needs to be redone. It is a difficult surgery in the first place but to have to do it again -.

I don't know why your first fusion didn't work and I can't help but wonder if the surgeon himself is not to blame. Did he not do something correctly? I'm pretty sure this would be my concern but I know absolutely nothing when it comes to fusions. This is just my first thought. I know most people tend to trust in their doctors, regardless of his level of expertise, and believe everything they are told. Experience has told me this simply isn't true. Many doctors, spinal surgeons, are self serving so I guess I'm just a little skeptical at your surgeon's skill level. Just my opinion.

Whatever you decide, good luck, Dale