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Thread: XLIF, TLIF, ALIF/also osteotomy definitions

  1. #1
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    XLIF, TLIF, ALIF/also osteotomy definitions

    I found all these terms confusing, so I wrote them all out, hope they are correct. If Linda or anyone who knows could explain why most of us have to be cut open front and back instead of just one or the other, please explain. I'm sorry, I know it's been explained before, but I'm still confused. Does it depend on the type of lumbar degeneration you have under your fusion? I would prefer to have a posterior-only surgery. However, I have also heard of anterior-only. Please explain. Thanks,

    XLIF: Extreme Lateral Interbody Fusion (incision on the side)

    TLIF: transforaminal lumbar interbody fusion (incision in the back)

    ALIF: Anterior lumbar interbody fusion (incision in the front)

    Spine Osteotomy:

    Spine osteotomy is a surgical procedure in which a section of the spinal bone is cut and removed to allow for correction of spinal alignment. Spine osteotomy is usually needed for correction of severe deformed, rigid and fixed spinal deformity when nonsurgical treatments do not relieve symptoms such as numbness, weakness, or pain due to nerve compression or when deformity is getting worse over time. A mild or flexible deformity is usually corrected through positioning and instrumentation.

    Severe spinal deformity may occur in conditions such as Scheuermann’s kyphosis, iatrogenic flat back, post-traumatic, neuromuscular, congenital, degenerative disorders and ankylosing spondylitis. Severe deformity causes symptoms that may include a subjective sense of imbalance, leaning forward (stooping), early fatigue, intractable pain and difficulty of horizontal gaze. A spine osteotomy procedure significantly improves these symptoms. A spine osteotomy reduces pain and restores balance so that the patient can stand erect without the need to flex their hips or knees. It also improves the gross appearance (cosmesis) of the patient and even makes a horizontal gaze possible to perform. Functional improvement of the visceral organs may also occur.

    Spine osteotomies can be broadly divided into three main types. The type of osteotomy used depends on both the location of the spinal deformity and on the amount of correction that is required. A spinal fusion with instrumentation may also be performed along with spine osteotomy to stabilize the spine and prevent further curvature. The three main types of osteotomy are:

    Smith-Petersen Osteotomy (SPO): SPO is recommended in patients in whom a relatively small amount of correction (approximately 10-20° for each level) is required. In this procedure, a section of bone is removed from the back of the spine causing the spine to lean more toward the back. The posterior ligament and facet joints are also removed from this area. Anterior bone graft is not used in this procedure as motion through the anterior portion of the spine or the discs is required for correction. SPO may be performed at one or multiple locations along the spine to restore lordosis.

    Pedicle Subtraction Osteotomy (PSO): PSO is recommended generally in patients in whom a correction of approximately 30° is required mainly at the lumbar level. PSO involves all three posterior, middle, and anterior columns of the spine. It involves the removal of posterior element and facet joints similar to a SPO and also removal of a portion of the vertebral body along with the pedicles. PSO allows for more correction of the lordosis than SPO.

    Vertebral Column Resection Osteotomy (VCR): VCR involves the complete removal of a single or multiple vertebral bodies. It allows for maximum correction that can be achieved with any spinal osteotomy. As VCR introduces a large defect in the spine, spinal fusion is also performed over these levels for reconstruction. Spinal fusion may involve the use of a structural autograft, structural allograft or metal cage. Initially, VCR was performed through a combined anterior and posterior approach but now it can also be performed through only a posterior approach.

  2. #2
    Join Date
    May 2008
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    reno,nevada
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    Some Friday night ALIF tidbits....

    From what I understand, if you have bad DDD this leads to severe vertrebral end plate damage, and ALIF is the only way to prepare the end plates. This cant be done with TLIF since they need to get in there and gain full access to the disc from the front. The prep or removal of the end plates is called a partial corpectomy. A full corpectomy is where the remove the whole vertebrae usually after a major trauma.....ectomy means removal, corp I think has something to do with the marines.Marine removal...... Ha ha (scoliosis forum humor)

    I had BMP used, and ALIF is the only FDA approved procedure for scoliosis surgery. Any other usage is considered “Off Label” and up to the surgeons discretion.

    I had an L1-Pelvis ALIF, then 2 days later a T2-Pelvis PLIF.

    Fusing from the front using a spacer or cage balances out the fusion. The weight of the spine compresses the grafting material and this help guarantee fusion. Posterior only methods do not fuse the front of the spine just the back side....Anterior access also gives more room to remove any bone spurs......The cages also lift up the spine and create more room for nerves, usually the ones that create leg pains...

    Abdominal surgical scars heal quickly......I was amazed at how quickly this happened.....

    I had no osteotomies since my sagittal curves were ok.....this balancing of kyphosis and lordosis from the side view is extremely important. Don’t even worry about the coronal curves.

    Gail posted someplace and I agree, T1, you need an accomplished revision surgeon.....

    You mentioned that you could barely walk a block. Years ago I was in Hawaii on one of my scoliosis maintenance trips and was on a 3AM hot tub trip for major pain. On the way back, I had to walk through a parking lot and ended up completely locked up and couldn’t take another step. Then it started raining.

    It rains hard in Hawaii

    I set my date...

    Ed
    49 yr old male, now 59, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  3. #3
    Join Date
    Aug 2012
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    San Francicsco Bay Area
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    Thank you so much for this explanation, Ed, it is most helpful. Also, I don't want to reinvent the wheel here, so please give me all you've got on BMP (Bone Morphogenetic Proteins) Thirty years ago they took bone from my hip for my surgery, which hurts FOREVER, so I'm assuming they use a bone bank or do they also use this BMP?

    Also, I have seen an accomplished revision surgeon, Serena Hu, and I posted all about this in my other posting. My pain is atypical and she does not know what is causing all of it.

    Thanks so much everyone, I am grateful to be part of this supportive community.

  4. #4
    Join Date
    May 2008
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    reno,nevada
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    ALIF tidbits continued....

    I had no bone used in surgeries. None. It was BMP and synthetic bone pastes....All scoliosis surgeons now are aware of the pain caused by pelvic “mining” and yes, bone has nerves. This is old news now...Its always a good idea to discuss the allograft, autograft, BMP and bone paste questions with your surgeon before any surgeries. BMP is pricy stuff,and a trying insurance issue. It is a Medtronics product called Infuse. Infuse kits. I have read that if you inject a drop under the skin, it will grow bone. In ALIF, its inserted in the cage outside of the operating area, encased in the insertion tooling which doesn’t allow any dripping......there is no application by a shaky hand, or needle. Its application and its insertion method is controlled. ALIF also is an advantage in the discectomy process since they have better access to the disc and removal of the disc in the area of the spinal cord is delicate and important....If any disc material is left, it can be a problem. TLIF does not afford that access and you can see by the animated TLIF videos online that they have to make the turn and through a very small hole. I would like to see studies on ALIF vs TLIF success rates and surgical testimonial on each methods difficulty and complication factor. Its why ALIF is selected by certain surgeons......I know my surgeon discussed my surgical attack with many others in the scoliosis community because my surgical attack was changed and the ALIF was added after careful thought. I am glad I waited, my procedure worked like a charm. DDD is actually everyone’s problem. Even non-scolis.

    We have extremely challenging spines, and as we age, we have body parts that degenerate. Our spines are so challenging that we could have 25 different pain producing problems or areas, and trying to locate these areas is hard or just about impossible. It’s why I rejected my shots when I had pain, it just didn’t make sense to put a new roof on a house if its falling down. When you need surgery, you need surgery.....

    “Symptoms, then, are in reality nothing but a cry from suffering organs” Jean-Marie Charcot

    The old Harrington rod invented in 1955, and its concept and technology was something that was sorely needed 60 years ago, it was a pioneering effort by Dr Harrington to try to save lives. Something had to be done, something radical.....regardless of what anyone thought about it. This is how progress is made, by trying new things.....Elon Musk is a person who tries new things....God I love that guy, he is the kind of person that should be involved in the medical community.....coordinate teams and ask the hard questions. Bite off more than you can chew, chew it, and don’t spit it out.

    For those that had any of the old systems installed years ago that are having problems it is an unfortunate thing for those left with lower lumbar levels untouched that have had pain problems. You just don’t fuse it all. With my success, I have thought to myself, “Fuse it all”, and I know, it’s a crazy thought. More surgery seems crazy, but if you need it due to your quality of life being in the gutter, and cant make it across the parking lot in the rain, you have to make the decision to bite the bullet.

    ALIF has been done for decades.....I believe first pioneered in Hong Kong for TB patients....Its one of many surgical procedures, these procedures of course need extensive training. Heavy duty revision surgeries need teams, multiple surgeons and doctors working together for success......I had 2 scoli surgeons and a elder vascular surgeon. 12 doctors reported in my hospital reports, the Synthe’s reps were there with a massive selection of hardware, it was quite a gathering.....I wanted them to film.....it didn’t happen and it should have.

    We have seen BMP fail in a 25 year old patient here on NSF.....Its not like its necessary, or the magical answer.....its just one parameter.

    I would hesitate if BMP is used in a non FDA approved method other than ALIF. Its not like BMP mishaps happen around here all the time, the Medtronic lawsuits were mainly about cervical surgeries gone bad, and these are not usually scoliosis surgeons doing these surgeries. Who has cervical scoliosis? Not too many people.

    Ed
    49 yr old male, now 59, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

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