ALIF Anyone?

[Sharon C]

Hi All!
I'm considering getting an ALIF procedure for my flatback (L-5-S-1) as I have mentioned in a previous post. I am ruling out the more drastic wedge osteotomy as too risky, and I can't opt to get to the premiere docs who might have better success with such a complex surgery as I am on my own. I would have the ALIF done locally by Drs. Fry and Mendoza in Carson City Nv. I've had scoli films and MRI done, and am a viable candidate. Doc Fry thinks I "don't look too bad" as far as my flatback is concerned; but I'm not interested in "looking better" just want to walk more comfortably any distance (no walks around the block, etc.) I need a cane or grocery cart etc. to keep comfortably upright, and would love to be able to walk again unassisted, or at least improve my current status to the point of being more comfortable around my own house, standing in line at the Post office etc., without needing my cane chair to sit on, walking to and from a business to my car, etc.

I am meeting with the younger Doc Mendoza December 1st also, as Dr. Fry is in his 60's now, and doing more assisting these days. He says they have both done many of these procedures. He tells me a "cage" would be inserted, with the front part higher and back lower, so that is what helps correct the "leaning forward". Sounds good on paper!


Has anyone here had this procedure done relatively recently (with the latest tech, etc.) and been happy or unhappy with the result? Trying to get as much info as possible.

Thanks!
Sharon Colley

[LindaRacine]

Hi All!
I'm considering getting an ALIF procedure for my flatback (L-5-S-1) as I have mentioned in a previous post. I am ruling out the more drastic wedge osteotomy as too risky, and I can't opt to get to the premiere docs who might have better success with such a complex surgery as I am on my own. I would have the ALIF done locally by Drs. Fry and Mendoza in Carson City Nv. I've had scoli films and MRI done, and am a viable candidate. Doc Fry thinks I "don't look too bad" as far as my flatback is concerned; but I'm not interested in "looking better" just want to walk more comfortably any distance (no walks around the block, etc.) I need a cane or grocery cart etc. to keep comfortably upright, and would love to be able to walk again unassisted, or at least improve my current status to the point of being more comfortable around my own house, standing in line at the Post office etc., without needing my cane chair to sit on, walking to and from a business to my car, etc.

I am meeting with the younger Doc Mendoza December 1st also, as Dr. Fry is in his 60's now, and doing more assisting these days. He says they have both done many of these procedures. He tells me a "cage" would be inserted, with the front part higher and back lower, so that is what helps correct the "leaning forward". Sounds good on paper!


Has anyone here had this procedure done relatively recently (with the latest tech, etc.) and been happy or unhappy with the result? Trying to get as much info as possible.

Thanks!
Sharon Colley

Hi Sharon...

I did have an ALIF, but it was part of a combined anterior/posterior procedure.

A standalone ALIF is not something I've heard of being done, but that doesn't mean it's not an option. It seems to me that there might be an issue because the back of your spine is almost certainly fused solidly at this point. Does a wedged cage have enough strength to stand up to a solid posterior fusion? I would do two things if I were you. First, I would ask what your surgeons think about the risk of requiring additional posterior surgery in the future. Second, I would try to get a second opinion from someone outside the current practice (UCSF would be the obvious choice).

--Linda

[Pooka1]

Can I just ask how addressing ONE level can be expected to change the torso position?

[titaniumed]

Can I just ask how addressing ONE level can be expected to change the torso position?

A wedged spacer to try to pitch her spine back.....like a tapered doorstop all the way down at the bottom.

They are probably thinking of using a plate in the front without pelvic anchors from the back.

I agree with Linda on the 2nd opinion.... If you look at fusion masses to the sacrum, they always have pelvic anchors. I have seen 1, 2 and 4 pelvic anchors online.

Tiger Woods had a standalone L5-S1 ALIF, but not for scoliosis....this is completely different.

I tried pitching forward 3-4" and walking and it wears you out quickly..... Thats not easy to do. I completely understand.

Ed

[titaniumed]

The most common indication to use pelvic fixation is with long fusions to the sacrum. Without this fixation, there is a high rate of pseudarthrosis at the lumbosacral junction, which is mostly due to the high biomechanical stress on this level.


https://www.wheelessonline.com/issls...nal-deformity/

Ed

[Sharon C]

Hi Sharon...

I did have an ALIF, but it was part of a combined anterior/posterior procedure.

A standalone ALIF is not something I've heard of being done, but that doesn't mean it's not an option. It seems to me that there might be an issue because the back of your spine is almost certainly fused solidly at this point. Does a wedged cage have enough strength to stand up to a solid posterior fusion? I would do two things if I were you. First, I would ask what your surgeons think about the risk of requiring additional posterior surgery in the future. Second, I would try to get a second opinion from someone outside the current practice (UCSF would be the obvious choice).

--Linda

Yes, my spine is solid for many years now. Dr Fry did say it would "probably" be in through the front, then securing it through the back too. He has suggested getting an opinion from those docs you recommended, as I copied and presented him with your recommendations before my initial appt. Is it possible to just have my films MRI results evaluated by them rather than a personal visit? I will ask about additional surgery on my next visit.

Thanks so much for you input!

[Sharon C]

A wedged spacer to try to pitch her spine back.....like a tapered doorstop all the way down at the bottom.

They are probably thinking of using a plate in the front without pelvic anchors from the back.

I agree with Linda on the 2nd opinion.... If you look at fusion masses to the sacrum, they always have pelvic anchors. I have seen 1, 2 and 4 pelvic anchors online.

Tiger Woods had a standalone L5-S1 ALIF, but not for scoliosis....this is completely different.

I tried pitching forward 3-4" and walking and it wears you out quickly..... Thats not easy to do. I completely understand.

Ed

Thanks ED!

[Sharon C]

Can I just ask how addressing ONE level can be expected to change the torso position?

That's what I am wondering too! He said the correction would be minimal, but thinks "I don't look that bad" so there's that. But would it be enough to change my life for the better? It's making me CRAZY!

[LindaRacine]

Yes, my spine is solid for many years now. Dr Fry did say it would "probably" be in through the front, then securing it through the back too. He has suggested getting an opinion from those docs you recommended, as I copied and presented him with your recommendations before my initial appt. Is it possible to just have my films MRI results evaluated by them rather than a personal visit? I will ask about additional surgery on my next visit.

Thanks so much for you input!

Hi Sharon...

Glad you clarified that. It makes sense that they would do anterior and posterior surgeries.

It may be possible to submit your films and have a telemedicine appointment with one of the surgeons, although I'm guessing there is some benefit to an in-person evaluation of your flatback. Give them a call at 415-353-2739. Drs. Berven and (Vedat) Deviren have the most experience with complex revisions, so I would try for one of them if possible. In addition to the MRI, one thing you'll need for sure are 36" A/P (or P/A) and lateral radiographs.

--Linda

[titaniumed]

Tapered cages

This article has a tapered spacer or cage in the diagram half way down the article. It's right below L5.

https://www.spineuniverse.com/exams-...inal-alignment


Ed

[Sharon C]

Hi Sharon...

Glad you clarified that. It makes sense that they would do anterior and posterior surgeries.

It may be possible to submit your films and have a telemedicine appointment with one of the surgeons, although I'm guessing there is some benefit to an in-person evaluation of your flatback. Give them a call at 415-353-2739. Drs. Berven and (Vedat) Deviren have the most experience with complex revisions, so I would try for one of them if possible. In addition to the MRI, one thing you'll need for sure are 36" A/P (or P/A) and lateral radiographs.

--Linda

Hi Linda,

What on earth are the radiographs you mention? Looked it up online but didn't really get it. Always thought MRIs are the "gold standard". So many details I don't know about, that's for sure.

[Sharon C]

This article has a tapered spacer or cage in the diagram half way down the article. It's right below L5.

https://www.spineuniverse.com/exams-...inal-alignment


Ed

Another interesting article. So much info, it's mind boggling. I've been waking up at night and going over these random facts-- and sure I won't get the surgery, then sure I should later in the day when the night terrors have subsided a bit.
I know it's something I have to wrap my own head around and no one can make the choice for me....:-(

[LindaRacine]

Hi Linda,

What on earth are the radiographs you mention? Looked it up online but didn't really get it. Always thought MRIs are the "gold standard". So many details I don't know about, that's for sure.

Those are the standard long cassette xrays, one view taken from either the front or the back, and one from the side. When flatback is an issue, they need to be able to see what the spine looks like under load (that is, not when lying down).

[jackieg412]

Some larger sites also have an xray called EOS. It is a low dose full body scan that is standing. They can see the whole body, hips, knees ,legs, head. All in one X-Ray.

[Sharon C]

Some larger sites also have an xray called EOS. It is a low dose full body scan that is standing. They can see the whole body, hips, knees ,legs, head. All in one X-Ray.

Wow. I just thought the scoli x-rays were enough.