I am having anterior and posterior lumbar fusion in a month for spondylolisthesis, central annular tear, moderate degenerative disc disease, para defect, and severe foraminal stenosis in L4-L5 and L5-S1! I saved this video so I can watch it again and again to prepare me! Thank you for making an awesome video!
@@Joe40511 My older brother is having Anterior lumbar interbody fusion (ALIF) with instrumentation, allograft, autograft, and BMP-2 on November 7th then on November 11th he's having a posterior surgery to insert a cage, I don't know the name of this surgery? The curve of his spine is 19% it will be brought to 60%, so worried about him. I pray your surgery and recovery are successful!!!
I’m scheduled to have this surgery done next month. Thank you for clearly explaining the procedure and especially the typical recovery process. You’ve set my mind at ease; I’ll be gracious to give my nerves the year they need to recover proper functioning.
I am a retired physician about to undergo L4-S1 TLIF. I have been treating my osteoarthritis conservatively for 4+ years. In the past 6 weeks my low back pain has severely negatively affected my QOL. MRI shows marked progression with severe nerve root compression at more than one level with new anterolisthesis that is grade1. Your video presentation is awesome! Reenforced what my neurosurgeon said. I would highly recommend it for lay people.
I'm about to have an ALIF and you were way more informative than my provider!!! THANK YOU for posting this!! I now understand exactly what I'm having done!
Hello Doctor! You are the most eloquent, responsive, and well dressed doctor I've seen. Thank for everything you do. I hope you can give an answer as you seem to understand and address all the nuances that others do not. I'm 42 and I'm in exceptional physical condition. I'm 6 weeks post op from ALIF with ROI-A cage, screws and rods for a bulging L5-S1 disc into the posterolateral and foraminal space in the right side with a very very slight 2mm spondylolisthesis. I've never had any issues my entire life until sciatica 6 months ago that got severe. I was convinced it was piriformis syndrome because there was zero back pain even though I know the odds are that 95 percent of sciatica comes from discs and I had the MRI showing the severe foraminal narrowing. I went to 1 Ortho and 2 Neurosurgeons and all 3 said ALIF would be the way to go based off my images and symptoms. 1 of the Neurosurgeons is the head at PENN so I wasn't messing around. They all dismissed piriformis syndrome. I'm now 6 weeks post op and I'm recovering fast as fit people usually do, but my leg symptoms are still there. I'm well aware that the cage gave me a couple mm more of height so there could be some nerve stretch but it's nothing crazy because my disc height wasn't terrible in the first place like a patient with DDD. My concern is that the ALIF approach still leaves some disc material in the spaces I needed removed due to the approach from the front and inability to remove 100 percent of the disc. My doctor said that would dry up and absorb. Of course only an MRI would show the proper soft tissue imaging to see if the foraminal piece of the disc is still touching the nerve. I've never heard any doctor address that ALIF doesn't decompress nerves as well as TLIF because of the lack of access to the back of the disc so I'm guessing it's not a huge deal. Could there still be disc on my nerve? What if I give it a solid 6 months and the leg still feels the exact same? Should I then seek out an endoscopic piriformis decompression? I have such a great understanding of the anatomy and what is going on and I just want it solved. The leg doesn't feel like it did at its worst point but it still feels like it did leading up to surgery. I'm hoping it's just that the nerve needs to heal because if not, I will have given up a vital piece of my anatomy for nothing and all the future risks that come with that.
I’m 44 years old and had ALIF done 6 months ago. My early signs of spinal stenosis was, of course back pain, but what triggered my doctor into getting me an MRI was tingling in my feet. It felt like bugs were crawling on my ankles and feet, then it progressively turned into severe pain. Along with the back pain I started to get horrible stomach pain/ nausea. After a few rounds of steroid injections ( which didn’t help) I was referred to a neurosurgeon. During the first five weeks post op I felt great. But, then the pain really intensified in my back, legs, and feet. My surgeon said this was normal as my spine is healing. He suggested that I walk several times a day, which did help. After 12 weeks post op I was finally able to go to physical therapy. They gave me great exercises to build back my core strength, then I was finally able to go back to work. I still experience pain episodes from time to time but I realize that I’m not fully healed yet so I still limit my bending, lifting. Unfortunately, I think I may have gotten a hernia in the last few weeks, which my surgeon said was possible because of the incision area. I have to let my doctor make that determination when I see him soon.
Your recovery process is very common. It is up and down for the first several months but how you feel at 1 year will be close to how you will feel long term.
I'm in the exact same position. I'm 6 weeks post op ALIF. I felt great for 4 weeks but the past 2 have been rough. Sciatica and some stiffness in my back is occurring. I'm also worried about a hernia going forward. What did you do to agitate your abs?
Thank you SO much for this wonderful video! I feel so much more confident about my procedure. I especially appreciate the detail you go into regarding by recovery. Knowing what to expect and the timelines for pain relief/recovery is incredibly helpful (and something not all doctors cover thoroughly enough). Thank you!!
Oh. My. God. Thankyou for this. I'm having a 2 day anterior/posterior spinal fusion but the first part is what freaks me out. Your description and chart alleviated my fear completely. I was so worried they were sifting through my abdomen and got all sleeved out. Not anymore ❤ You're fantastic at explaining this. Thankyou thankyou
Dr. Armagani! Thank you so much for explaining this procedure so well. I am in awe. Thank you and others like you for your vast knowledge and precise abilities. You have relieved my fear.
I recently had this procedure done. I searched the internet for a month for a good video or even websites on this surgery. I didn’t find anything that great. This video is excellent!! 13 days post operative and it was still extremely informative to me. Gives me a better understanding of what happened and is happening. Thank you!
I also found out I have soft bone during the surgery. It does explain a lot about all the broken bones I have indured. Do you have videos on how to treat it. There’s a lot of information on osteoporosis but not so much soft bone.
I am scheduled for an ALIF later this summer, and your video is by far the BEST explanation of this surgical procedure on TH-cam. Thank you very much for sharing!
Probably the most informative, articulated, diagramed , and well produced medical video I have ever seen. You give Dr. Choll in California a run for his money. Wow. I have spondy of the L 5 S1 and 2 grade 3 Anterolistthesis on L5 S1. No leg issues but debilitating back spasms at times. Would love to see an O. R. video.
This was the best explanation of ALIF surgery or and procedure I ever watched. I’ll be having this surgery in a month and I feel more confident of what to expect pre and post surgery. Thank you
I’ve had ALIF spinal surgery 12-2-2020… that was the 3rd spinal, the 1st & 2nd ones was botched. They put a spacer in with NO screws& it fell out & got tangled/twisted in my nerves.. 3yrs. after ALIF, I’m still in pain because of nerves. I’m only 46. I was 41 going on 42! I’m tired of crying and being in constant pain
Thank you so very much for this information. Also concerned about the pending surgery, you have clearly explained what to expect and I am more comfortable with it. Thank you again.
This is phenomenal in its complete description and visuals for laypersons. Thank you for this gift of understanding from one gifted to heal with restorative medical skill. Be blessed.
I’m getting this done 1 month from today. I’m pretty nervous about it but you laid it all out in an easy to understand way. Thank you so much. My doctor is great and I have a pre op appointment set to go over the procedure but it’s nice to be able visualize what’s going to happen.
Thanks for explaining clearly Does anyone have this surgery already? How you feel after 6 months 1,2 years I have appointment in 3 months to do my s1 disc I'm nervous so bad
Having this surgery next week at Spine Institute in Shreveport, Louisiana, by Dr Utter. I pray it goes well. Your video helped me to understand and relax more about having the surgery. Will be giving an update later on. Thank you for your video.
I am getting prepared for spine surgery at the end of June 2022. Watching your video has helped me understand what will/ could happen. I’m not worried anymore. Thank you for the clarity and straightforwardness.
@@boogie99025612 any suggestion on what nutrition we can have to help that area grow back faster? bone meal, collagen, wheatgerm .................. these kind of things maybe ?
I love your videos because they’re so easy to understand. I’m having neck & back surgery this year & your videos really help me understand what I will be going through. THANK YOU
i've had this done 11 years ago ALIF L4-L5-S1 My L4-L5 level isn't fused. So i actually rather choosed PLIF through the back. I'm not going to surgery anymore, it's really a major procedure on multiple levels. you also have to wear a corset for 3-6 months.
I really do appreciate the explanation of this surgery I’m having it done in the next 2-3weeks so tired of the pain but at the same time nervous about it but the pain got me kinda excited for the relief of pain ty
@@jamesgawne642 I pray you get everything out of getting it done (relief from pain) because that the part I’m looking ph so forward to but at same time this really my first time for major surgery and I’m 50 years old
Good luck, David. Just remember. It's a marathon not a sprint. You'll get the majority of your recovery within the first 12 weeks but full recovery isn't for 1 year. During that time period you will have ups and downs but don't get discouraged if that occurs. Ride the waves of the recovery and how you feel at 1 year will be how you feel long term.
Hey I just got mine done and at first I wasn’t in to much pain I think it was the narcos. But since Iv been home I haven’t taken any medicine I hope this pain is just from the surgery been about a week now. I have accidentally twisted does that effect the healing procedure if the twist isn’t like really that much of a twist if that makes sense? I didn’t have you as my doctor as well but more informative
I love how you explained the Alif procedure, so others can get a better understanding what to expect. Dr. you were very patience explaining the details.. on Dec 1 , 2021 I had to have one L4,L5,S1. I thank God for blessing them with knowledge and understanding the Wisdom . Do become great Doctors.❤️
Hi Steph I hope you are doing fine by now. I’m going to have mine in two months, I’m very curious and nervous. Can you tell me how’s was your surgery as well? Thank you
Is the disc completely removed during this procedure ? What happens if the disc is herniated generating central stenosis ? Should the compressing elements be removed , or the removal of the disc elements will render thos elements loose and non compressive ? I always wondered about this detail.
Thank you I'm having this done in 3wks very very scared cause I had a surgery similar to this about 4yrs ago which should have been done this way and wasn't and the new dr said the reason I'm still in so much cause I'm never healed from my surgery 4yrs ago so in 3wks he will be performing this surgery very scared of the pain the first time I stayed in lots of pain for about the first year and I'm scared it's going to be the same way. Will I be in constant pain after this surgery for a long time don't get me wrong I really trust this dr and he really let me feel safe and understandable I'm just afraid of the pain!!!!!!!!!
@@mynarcissistjourney hi, well surgery stopped my spine collapsing,preventing paralysis and incontinence...but I have nerve damage,numbness pain post op. Went on to have a spinal cord stimulator. I am a wheelchair user. But honestly no regrets, the surgery did what it was meant to.
thank you for informative, precise and understandable description of the procedure that i wish my surgeon would have provided as my surgery is coming up.So, thank you again for sharing your knowledge and taking the time to do so
I'm halfway through the video and it's a great explanation. My surgeon has recommended this surgery which I have to decide in the next month if I'm having it done. He recommended it because he doesn't have to cut through the back muscles, BUT, it seems much riskier than going through the back for the same procedure. Comment please.
Dear Dr. Armaghani My surgeon says, he only removed L5S1 disk, and now vertebraes L5 and S1 stick together? Is it possible? Without any medical device between?
Thank you so much for taking the time to create such an informed video. I am a 22 year old female with Spondylolisthesis Grade 2 L5S1 with a pars defect in which the disc is worn down all the way. I was told I need fusion surgery. However, one surgeon said he would do an ALIF anterior/posterior and another said he would do ALIF anterior only. I understand that anterior only is less invasive and would provide a quicker recovery but there could be an issue in regards to the screws not being as strong as well as it possibly taking longer for the bone to grow because there's not as much as stability as if you secure it with bigger screws from the back. I would really value any opinion you can give me. Thank you so much!
That is a fantastic question. I can speak in generalities about spondylolisthesis with pars defects. Placing a cage between the L5 and S1 bones is the main treatment but some people like to go through the front (ALIF) and others like to go through the back (TLIF). Those who choose ALIF can just put the cage there and others like to place the cage through the front but additional screws in the back. Think of the screws in the back as a "belt and suspenders" approach to keep L5 and S1 still so you can heal the fusion through the cage. From my understanding, there isn't a lot of great evidence for one being much better than the other. In general, in my practice, patients with a spondylolisthesis at L5/S1 always get screws in the back in addition to the ALIF cage but that is because I'm a little more conservative than most.
@@ArmaghaniSpine Dr. Thank you so much for the video and explanation. I am much comfortable about the sugary. I am 45 female, was a professional volleyball player. I had same condition as that 22 years of patient. L5S1 chronically pars defect with Grade 1 spondylilosthesis. The Dr. also suggested ALIF plus put screws at the back to stabilized the spine. May I ask would those surgeries complete at the same time? Are those surgeries all minimally invasive surgery. Thanks for your time!
Thank you so much for your explanation of this surgery. I’m 41 male and had L4-S1 ALIF surgery on dec 18th 2024, I’m about 13 weeks out and doing relatively well recovering but having so flare ups and bad days depending on on how my day went. I’m in physical therapy and I am seeing progress after each session, but the exercises are strenuous, even though they are easy exercises to perform. My body has become deconditioned. My chief complaint is the fatigue I face day to day, I feel as if it prevents me from achieving even the easiest of tasks sometimes. Sometimes after a walk, errands, PT, light chores I feel as if I ran a marathon. Does anyone else experience this sort of problem who’s has some sort of spinal surgery? Will this feeling go away? I am feel someone down mentally about this. It’s hard to stay focused on essential daily tasks when I feel so tired day to day.
Thank you for this informative video. I just found out I will have this procedure on my L5-S1 June 1st in Houston at Methodist hospital. I had a foraminotomy a few years ago and it didn't last long. I'm ready for relief my feet go to sleep when I stand more than a few minutes.
Hello Doctor! Thank you very much for this video. I'm 12 days post-op ALIF L3/L4 surgery. I had it done because of the DDD and back pain located mainly in back muscles. I didn't have any nerve issues before the surgery, only local pain in lower back. I still feel my old, well-known pain from before the surgery. My surgeon told me that I shouldn't worry about it and it will subside. Could you comment on it somehow? Is it normal to have the same back pain at this point in my recovery process? Best regards!
In general, I tell my patients that for the first month or 2 they will "hate me" because of the pain in their back due to the stretch of the ligaments from putting the cage in. There are good days and bad days during this time. The further they get out from surgery the more good days they will have than bad but full recovery isn't for 9-12 months. So i generally counsel patients that how they feel at 9-12 months will be how they feel long term so it is definitely more of a marathon than a sprint. good luck!
I’m having anterior/ posterior 3 level l4-s1 next month. This surgery really scares me. I’ve had 18 different operations in my life but this one has me trying worried. I have muscular dystrophy so the surgeon wants to put metal rods and screws on the posterior side also for more support. Is this common?
Please do more of these. So informative. I had a decompression and fusion of L2 to S1 plus fusion. That was a year ago. In a lot of pain from the fusion. What can I do. Can a minimally invade correction be done ??
Thank you for your kind words. Visit your surgeon after surgery to ensure that you are fully fused. Not being fused is a common cause, in general, for long-term pain following surgery.
I am having to have this surgery done but in addition to the ALIF my spine doctor is saying I will have to have another surgery the next day or so to put screws in my back. Would you be able to describe what they will be doing in that procedure.
It sounds like a usual "staged" procedure. Sometimes hospitals require cases that require going through the front and the back be split into different days.
I just has a 2 level lumbar spinal fusion from L3 to L5. My surgeon had trouble placing the cage from a TLIF at L4/L5. I still have significant foramina stenosis at that level and I am wondering if an ALIF would be the best follow up. Is placement of the cage guaranteed with ALIF or might he still not be able to get a cage placed? Or would a better follow up be a decompression?.
Hi, Marco. There is a very low percentage chance on retrograde ejaculation which could occur (some studies average around 8% in men) which may hurt chances at having children, but this usually does not cause erectile dysfunction. There are additional techniques and precautions we take in surgery that we have learned over the last 20 years or so that lowers this risk even more.
@@ArmaghaniSpine Thanks for responding doctor. That’s exactly what my doctor told me. I’m expected to have ALIF/PLIF and there is a risk in males regarding retrograde ejaculation. But my doctor told me that the risk is pretty low and there shouldn’t be any problems with erections afterwards. I feel better but I’m still worried about the whole surgery itself.
@@Besokool Yes. Surgery was done. I had no choice. I was in so much pain :(. Almost no life. I barely started therapy. No complication with surgery. I do hurt some when I walked a lot but the doctor told me that the nerve is very slow to heal. So just keeping positive.
@@marcoriv9016 Thanks for responding. I'm probably going to end up with same type of procedure. If you don't mind, was the recovery really painful? Do you feel like it will be a significant improvement over time? Thanks for any info.
I saw my Neurosurgeon on Thursday and due to severe Spondylolthesis L5/S1, numerous Pars defect, buldging disks, scoliosis. This is the surgery I will be having before the end of this year. Terrified!
This is the surgery I had, they flipped me over to put in the other set of screws. I wished I was on a liquid diet, my constipation was horrible to pass. Had to take a enema on a regular basis, stool softeners don’t work. Excellent videos.
Constipation is certainly something that can occur following this surgery. The reason being is whenever the sack that holds the intestines (peritoneum) is manipulated, it can occasionally take a little bit of time for the intestines to start working correctly again (few days at most). It's almost as if the intestines are "shocked" when they are manipulated during surgery and need some time to feel comfortable to start moving again. I almost always do a mini-bowel prep like you would for a colonoscopy the day before surgery and we try to limit opioids during and immediately after surgery. This has cut down significantly on the constipation issues to the point where I haven't had a problem in a few years now. Thank you for sharing your thoughts and experiences it is invaluable to others.
@@ArmaghaniSpine New development, every time I have to cough I feel pain all the way down my spine. What do you think this could possibly mean? I also have swelling on my back that won’t stay down after icing. I had surgery on Jan 24th, so it’s been 2 weeks so far, I get flair ups if I do to much. I am off Meloxicam cause it’s hard on my stomach. Do you think I might have a bad case of inflammation?
Dr Armaghani I had this procedure last November 2021 and when I came out of surgery my diaphragm was paralyzed and part of my lung was collapsed. Have you ever heard of this. I had to have plication surgery on my diaphragm to get it off my lower lung.
Hello Dr., I have a question I’m having this surgery done December 6, and I was wondering would I be ok having this surgery with a hiatal hernia? Thanks
Not a lot is published on hybrid procedures but I do, personally, believe that disk replacement is what we are going to be doing in the future much more than fusions.
In your video state state No bending/twisting/lifting over 20 lbs. So, are you saying that it's ok to do those things without any weight right away? I understand that if so, it needs to be moderate...
Absolutely amazing , everything simplified. Except that shifting/pressing of internal organs in the stomach was pretty scary. You are indeed a great surgeon. Many thanks for the video.
Hi Doc, thanks for this excellent presentation. I am not sure if I missed it, but you didn't mention anything about autograft bone that you harvest from other areas compared to the TLIF approach. If I understand right you ony place the cage in the IVD space? Many thanks for your video once more :)
Good question, indeed. We do have to "bonegraft" when doing this approach meaning we have to put something inside the cage to help aid the bones on either side of the disk that we are fusing to send cells across the cage to form a solid fusion. People use a number of different manmade options which don't involve taking any bone from elsewhere in your body which decreases post-operative pain. These are called "allografts" as they come from a source that isn't you. Personally, i like to use bone morphogenic protein-2 or BMP-2 as it's called. This is an FDA approved allograft that improves fusion rates in ALIFs to greater than 90-95% and has been studied extensively over the last 20+ years to the point now that we are very precise in the amount that we put into the cages to maximize fusion rates but decrease any potential negatives which are very rare.
Dr. Armaghani, thank you so much! I am so grateful that I was one of the select patients ALIF was appropriate for. After my fusion, my wife and I are able to fornicate without me experiencing pain. (the bad kind, that is) I couldn't recommend you enough!
Thank you very much for your excellent video, I have a question about the fusion procedure, do we lose mobility and/or flexibility with the fusion? I need an L4-L5-S1 ALIF surgery
With an L4-S1 fusion you will notice some loss of range of motion particularly in twisting and bending side to side. Just at L5/S1 or just at L4/5 you wouldn't really notice a difference.
Hi Armaghani, what’s the difference between an orthopedic surgeon and Neurologist surgeon for this type of surgery? I need to do one and I talked to a neurologist friend and he recommended it was better to do it with a neurosurgeon
Thank you for these excellent videos. Your descriptions of anatomy are so helpful in understanding the sources of pain. I will soon have a L4-L5 laminectomy for central and foraminal stenosis and a fusion due to spondolithesis grade 2. Which of your videos might apply to this type of fusion to bring vertebrae into alignment? Your laminectomy video was excellent.
WHAT??? So, you don't use the WILTSE method or midline on the back where you now place the hardware on the 2 vertebrae where you placed the cage to structurally stabilize it?
I think this is the complete knowledge. I wish we staying in a same place. Buy the way sir I'm also suffering from Early degenerative lumbar spondylosis disease so this incision procedure will go on with me?
great question. you can partially yes but it isn't something we (or I rather) routinely do. if im doing surgery through the front I am banking on the increase in the space between the bones to be enough to take the pressure off the nerves. About 10-15% of the time it doesn't quite do it enough to the patient's liking and in those situations we go back 6 months later for a small, minimally invasive, outpatient bone removal from the back to make sure nothing is touching the nerve anymore.
@@ArmaghaniSpine thank you so much for the reply. I had a discectomy/laminectomy 8 months ago. Had extremes of back and nerve pain. Over a course of 7 months, I finally got rid of the nerve pain my limiting my movement and diet. Back pain always stuck with me(couldn’t bend). My bottom disc ruptured since then, but never got relief from surgery. My bottom disc is beat up even though I’m 38/male. Got very bad inflammation/ back pain that seems to stem from the bottom disc. The rest of my spine seems to feel unstable since the surgery. Just curious if an alif would be beneficial? I currently haven’t had a quality of life in a year and a half. Your responses are greatly appreciated so thank you again.
Would a fusion be required if you have the disk space but instead have a Grade 1 Spondylolisthesis? While the Grade 1 hasn't increased in years, there is movement from Grade 1 to 0 when laying down. Is this movement normal with a Grade 1 or do some patients keep the Grade one steady between standing and laying down?
some patients do keep the grade 1 steady between standing and laying down. occasionally in older individuals who can't undergo fusions, you can remove bone and free up the nerve on 1 side with good result but doing it on both sides will almost certainly lead to a fusion at some point.
I am having anterior and posterior lumbar fusion in a month for spondylolisthesis, central annular tear, moderate degenerative disc disease, para defect, and severe foraminal stenosis in L4-L5 and L5-S1!
I saved this video so I can watch it again and again to prepare me!
Thank you for making an awesome video!
*pars defect
Hello friend how you doing now??
I'm having this done in November
@@Joe40511 My older brother is having Anterior lumbar interbody fusion (ALIF) with instrumentation, allograft, autograft, and BMP-2 on November 7th then on November 11th he's having a posterior surgery to insert a cage, I don't know the name of this surgery? The curve of his spine is 19% it will be brought to 60%, so worried about him. I pray your surgery and recovery are successful!!!
@@Joe40511having mine done 11/11
I had this procedure done September 29,2022. Completely changed my life and I'm so grateful! God is so great!
Hi Snowboarding72, I'm scheduled for Feb 27 for mind. Question: Did you have a vascular surgeon assist in your surgery?
@@kcb3rdI have it on Jan 23rd... I have a vascular surgeon assisting my spine surgeon
@@kcb3rd I'm having it Feb 2. There will be a vascular surgeon.
I think you mean your surgeon is great.
@brianmacintire3064 hello friend how you doing now?
Excellent! Easily the most comprehensive explanation of this procedure on TH-cam.
I’m scheduled to have this surgery done next month. Thank you for clearly explaining the procedure and especially the typical recovery process. You’ve set my mind at ease; I’ll be gracious to give my nerves the year they need to recover proper functioning.
How did your surgery and recovery go?
I am a retired physician about to undergo L4-S1 TLIF. I have been treating my osteoarthritis conservatively for 4+ years. In the past 6 weeks my low back pain has severely negatively affected my QOL. MRI shows marked progression with severe nerve root compression at more than one level with new anterolisthesis that is grade1. Your video presentation is awesome! Reenforced what my neurosurgeon said. I would highly recommend it for lay people.
Good luck, Dr. Wassum!
I'm about to have an ALIF and you were way more informative than my provider!!! THANK YOU for posting this!! I now understand exactly what I'm having done!
You are so welcome!
Hello friend how you doing now??
I am obsessed with you videos, they are so educational and easy to understand. 10/10!!!! Please don't stop creating these gems.
Thank you, Amy!
@@ArmaghaniSpine is ALIF better than TLIF for runners?
Great job with the explanations of the ALIF process. Thank you.
B
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Very helpful. My wife just had this procedure today so I was looking for a thorough explanation. You did great.
Hello Doctor! You are the most eloquent, responsive, and well dressed doctor I've seen. Thank for everything you do. I hope you can give an answer as you seem to understand and address all the nuances that others do not.
I'm 42 and I'm in exceptional physical condition. I'm 6 weeks post op from ALIF with ROI-A cage, screws and rods for a bulging L5-S1 disc into the posterolateral and foraminal space in the right side with a very very slight 2mm spondylolisthesis. I've never had any issues my entire life until sciatica 6 months ago that got severe. I was convinced it was piriformis syndrome because there was zero back pain even though I know the odds are that 95 percent of sciatica comes from discs and I had the MRI showing the severe foraminal narrowing. I went to 1 Ortho and 2 Neurosurgeons and all 3 said ALIF would be the way to go based off my images and symptoms. 1 of the Neurosurgeons is the head at PENN so I wasn't messing around. They all dismissed piriformis syndrome. I'm now 6 weeks post op and I'm recovering fast as fit people usually do, but my leg symptoms are still there. I'm well aware that the cage gave me a couple mm more of height so there could be some nerve stretch but it's nothing crazy because my disc height wasn't terrible in the first place like a patient with DDD. My concern is that the ALIF approach still leaves some disc material in the spaces I needed removed due to the approach from the front and inability to remove 100 percent of the disc. My doctor said that would dry up and absorb. Of course only an MRI would show the proper soft tissue imaging to see if the foraminal piece of the disc is still touching the nerve. I've never heard any doctor address that ALIF doesn't decompress nerves as well as TLIF because of the lack of access to the back of the disc so I'm guessing it's not a huge deal. Could there still be disc on my nerve? What if I give it a solid 6 months and the leg still feels the exact same? Should I then seek out an endoscopic piriformis decompression? I have such a great understanding of the anatomy and what is going on and I just want it solved. The leg doesn't feel like it did at its worst point but it still feels like it did leading up to surgery. I'm hoping it's just that the nerve needs to heal because if not, I will have given up a vital piece of my anatomy for nothing and all the future risks that come with that.
Awesome explanations, especially for patients that will be undergoing this surgery. Takes the unknown away. Thank you for the amazing visuals.
You are very welcome, Bill!
I’m 44 years old and had ALIF done 6 months ago. My early signs of spinal stenosis was, of course back pain, but what triggered my doctor into getting me an MRI was tingling in my feet. It felt like bugs were crawling on my ankles and feet, then it progressively turned into severe pain. Along with the back pain I started to get horrible stomach pain/ nausea.
After a few rounds of steroid injections ( which didn’t help) I was referred to a neurosurgeon. During the first five weeks post op I felt great. But, then the pain really intensified in my back, legs, and feet. My surgeon said this was normal as my spine is healing. He suggested that I walk several times a day, which did help. After 12 weeks post op I was finally able to go to physical therapy. They gave me great exercises to build back my core strength, then I was finally able to go back to work.
I still experience pain episodes from time to time but I realize that I’m not fully healed yet so I still limit my bending, lifting.
Unfortunately, I think I may have gotten a hernia in the last few weeks, which my surgeon said was possible because of the incision area. I have to let my doctor make that determination when I see him soon.
Your recovery process is very common. It is up and down for the first several months but how you feel at 1 year will be close to how you will feel long term.
I'm in the exact same position. I'm 6 weeks post op ALIF. I felt great for 4 weeks but the past 2 have been rough. Sciatica and some stiffness in my back is occurring. I'm also worried about a hernia going forward. What did you do to agitate your abs?
Thank you SO much for this wonderful video! I feel so much more confident about my procedure. I especially appreciate the detail you go into regarding by recovery. Knowing what to expect and the timelines for pain relief/recovery is incredibly helpful (and something not all doctors cover thoroughly enough). Thank you!!
You are so welcome!
Oh. My. God. Thankyou for this. I'm having a 2 day anterior/posterior spinal fusion but the first part is what freaks me out. Your description and chart alleviated my fear completely. I was so worried they were sifting through my abdomen and got all sleeved out. Not anymore ❤
You're fantastic at explaining this. Thankyou thankyou
Dr. Armagani! Thank you so much for explaining this procedure so well. I am in awe. Thank you and others like you for your vast knowledge and precise abilities. You have relieved my fear.
This video is so helpful and just incredible. Thank you so much for providing such a generous service. You’re a wonderful human!! TY!
I recently had this procedure done. I searched the internet for a month for a good video or even websites on this surgery. I didn’t find anything that great. This video is excellent!! 13 days post operative and it was still extremely informative to me. Gives me a better understanding of what happened and is happening. Thank you!
I also found out I have soft bone during the surgery. It does explain a lot about all the broken bones I have indured. Do you have videos on how to treat it. There’s a lot of information on osteoporosis but not so much soft bone.
hope you are continuing to do well!
I am scheduled for an ALIF later this summer, and your video is by far the BEST explanation of this surgical procedure on TH-cam. Thank you very much for sharing!
good luck! it's one of my favorite procedures and patients do great
How was your surgery
@ArmaghaniSpine, my husbands surgeon recommended, but he didn't mention vascular surgeon as part of the surgery team.
Probably the most informative, articulated, diagramed , and well produced medical video I have ever seen. You give Dr. Choll in California a run for his money. Wow. I have spondy of the L 5 S1 and 2 grade 3 Anterolistthesis on L5 S1. No leg issues but debilitating back spasms at times. Would love to see an O. R. video.
thank you for the kind words. Dr Kim in California has great videos
This was the best explanation of ALIF surgery or and procedure I ever watched. I’ll be having this surgery in a month and I feel more confident of what to expect pre and post surgery. Thank you
I’ve had ALIF spinal surgery 12-2-2020… that was the 3rd spinal, the 1st & 2nd ones was botched. They put a spacer in with NO screws& it fell out & got tangled/twisted in my nerves.. 3yrs. after ALIF, I’m still in pain because of nerves. I’m only 46. I was 41 going on 42! I’m tired of crying and being in constant pain
U needed screws. I am sorry you went through that.
So sorry 😔
Sorry to hear that you’re in so much pain
Да, и в России есть врачи с кривыми руками......
Thank you so very much for this information. Also concerned about the pending surgery, you have clearly explained what to expect and I am more comfortable with it. Thank you again.
This is phenomenal in its complete description and visuals for laypersons. Thank you for this gift of understanding from one gifted to heal with restorative medical skill. Be blessed.
I’m getting this done 1 month from today. I’m pretty nervous about it but you laid it all out in an easy to understand way. Thank you so much. My doctor is great and I have a pre op appointment set to go over the procedure but it’s nice to be able visualize what’s going to happen.
You'll do great!
Gpaint, how did the fusion surgery go? Was it a success? Debating on mine, bc i have ddd and buldging disc.
How did it go? Hope all well well.
I have to get a posterior and anterior fusion done for spondolythesis and forminal stenosis! I’m nervous
Getting ready for this surgery. Your explanation was outstanding. Very detailed and informative. Thank you
I had this done along with Posterior. Fortunately, no major complications.
Great to hear you are doing well!
Hello friend how you doing now??
Thanks for explaining clearly
Does anyone have this surgery already?
How you feel after 6 months 1,2 years
I have appointment in 3 months to do my s1 disc
I'm nervous so bad
Having this surgery next week at Spine Institute in Shreveport, Louisiana, by Dr Utter. I pray it goes well. Your video helped me to understand and relax more about having the surgery.
Will be giving an update later on. Thank you for your video.
Good luck! It's a well known Institute, I'm sure you are in good hands.
Barbara, how did the surgery go? Im debating on it...
I am getting prepared for spine surgery at the end of June 2022. Watching your video has helped me understand what will/ could happen. I’m not worried anymore. Thank you for the clarity and straightforwardness.
good luck!
How was your surgery? Hope all went well.
@@maxbelski it went well. I am even back to work earlier than expected.
@@boogie99025612 any suggestion on what nutrition we can have to help that area grow back faster? bone meal, collagen, wheatgerm .................. these kind of things maybe ?
I love your videos because they’re so easy to understand. I’m having neck & back surgery this year & your videos really help me understand what I will be going through. THANK YOU
You're most welcome.
i've had this done 11 years ago ALIF L4-L5-S1 My L4-L5 level isn't fused. So i actually rather choosed PLIF through the back. I'm not going to surgery anymore, it's really a major procedure on multiple levels. you also have to wear a corset for 3-6 months.
Your graphics and layman’s explanations are the best! You are better than Guyton!
I really do appreciate the explanation of this surgery I’m having it done in the next 2-3weeks so tired of the pain but at the same time nervous about it but the pain got me kinda excited for the relief of pain ty
Had the procedure on 2/16/21 (not this doctor) but very pleased with the results so far
@@jamesgawne642 I pray you get everything out of getting it done (relief from pain) because that the part I’m looking ph so forward to but at same time this really my first time for major surgery and I’m 50 years old
Good luck, David. Just remember. It's a marathon not a sprint. You'll get the majority of your recovery within the first 12 weeks but full recovery isn't for 1 year. During that time period you will have ups and downs but don't get discouraged if that occurs. Ride the waves of the recovery and how you feel at 1 year will be how you feel long term.
@@ArmaghaniSpine thank you sir I will definitely remember that
Hey I just got mine done and at first I wasn’t in to much pain I think it was the narcos. But since Iv been home I haven’t taken any medicine I hope this pain is just from the surgery been about a week now. I have accidentally twisted does that effect the healing procedure if the twist isn’t like really that much of a twist if that makes sense? I didn’t have you as my doctor as well but more informative
Excellent explanation. I had this procedure and my surgeon did not explain it as well as Dr. Armaghani did in this short video.
I'm about to have this procedure. Thanks for this video it makes me feel better . Thanks Doctor ❤️🙏
I love how you explained the Alif procedure, so others can get a better understanding what to expect. Dr. you were very patience explaining the details.. on Dec 1 , 2021 I had to have one L4,L5,S1. I thank God for blessing them with knowledge and understanding the Wisdom . Do become great Doctors.❤️
Good luck!
Hello friend how you doing now?
I just had this Done!!! Thank you soo much for this video!!!!
Your videos are so informative and thorough! Thank you so much for sharing.
Amazing explanations! I’m having an ALIF next week and this made me feel way more informed and at ease.
Good luck!
How are you?Alif is ok?
Hi Steph I hope you are doing fine by now. I’m going to have mine in two months, I’m very curious and nervous. Can you tell me how’s was your surgery as well? Thank you
@@jazminjimenez1240 yes doing really well. Best decision I ever made, it’s rough at first but I’m 5 months out and have no pain at all.
@@stephhayward8455 I’m so happy to hear that!! Great!! Thank you for your response
Wow so informative the best video I've seen. Thanks 4 posting. A surgery I will be having.
Thanks doc. I’m getting this next week. This was really helpful.
good luck!
Is the disc completely removed during this procedure ? What happens if the disc is herniated generating central stenosis ? Should the compressing elements be removed , or the removal of the disc elements will render thos elements loose and non compressive ? I always wondered about this detail.
Thank you I'm having this done in 3wks very very scared cause I had a surgery similar to this about 4yrs ago which should have been done this way and wasn't and the new dr said the reason I'm still in so much cause I'm never healed from my surgery 4yrs ago so in 3wks he will be performing this surgery very scared of the pain the first time I stayed in lots of pain for about the first year and I'm scared it's going to be the same way. Will I be in constant pain after this surgery for a long time don't get me wrong I really trust this dr and he really let me feel safe and understandable I'm just afraid of the pain!!!!!!!!!
Excellent explanation. Very clear and complete.
I'm 6yrs post alif,the surgery still fascinates me, despite having problems...nerve damage,numbness.
Hi Julie do you have many restrictions in life after surgery?
@@mynarcissistjourney hi, well surgery stopped my spine collapsing,preventing paralysis and incontinence...but I have nerve damage,numbness pain post op. Went on to have a spinal cord stimulator.
I am a wheelchair user. But honestly no regrets, the surgery did what it was meant to.
Very informative and well detailed verbally as well visibly. Thank you for the video/lecture..
Fantastic. I'm an IT guy (embedded, so close to the 'guts' of a computer), and I find this fascinating. Thank you.
thanks for the kind words
thank you for informative, precise and understandable description of the procedure that i wish my surgeon would have provided as my surgery is coming up.So, thank you again for sharing your knowledge and taking the time to do so
You're most welcome!
This guy good I have spinal stenosis operation soon. Going to NYC hospital special surgery
top notch place. good luck!
I'm halfway through the video and it's a great explanation. My surgeon has recommended this surgery which I have to decide in the next month if I'm having it done. He recommended it because he doesn't have to cut through the back muscles, BUT, it seems much riskier than going through the back for the same procedure.
Comment please.
This was so very easy to follow. Thanks so very much im a candidate for this procedure.
Thanks so much!
Thank you for u derstanding the procedure .as a medical coder it is very helpfull
Thanks for this video, doc. I am having this procedure in less than two weeks and so afraid to do it. This helps so much.
hang in there!
Hello friend how you doing now?
Dear Dr. Armaghani
My surgeon says, he only removed L5S1 disk, and now vertebraes L5 and S1 stick together?
Is it possible? Without any medical device between?
Thank you so much I left hospital with dos or donts only when it came to pain meds
you're most welcome
That was an excellent presentation. Go Gators!
Thank you so much for taking the time to create such an informed video. I am a 22 year old female with Spondylolisthesis Grade 2 L5S1 with a pars defect in which the disc is worn down all the way. I was told I need fusion surgery. However, one surgeon said he would do an ALIF anterior/posterior and another said he would do ALIF anterior only. I understand that anterior only is less invasive and would provide a quicker recovery but there could be an issue in regards to the screws not being as strong as well as it possibly taking longer for the bone to grow because there's not as much as stability as if you secure it with bigger screws from the back. I would really value any opinion you can give me. Thank you so much!
That is a fantastic question. I can speak in generalities about spondylolisthesis with pars defects. Placing a cage between the L5 and S1 bones is the main treatment but some people like to go through the front (ALIF) and others like to go through the back (TLIF). Those who choose ALIF can just put the cage there and others like to place the cage through the front but additional screws in the back. Think of the screws in the back as a "belt and suspenders" approach to keep L5 and S1 still so you can heal the fusion through the cage. From my understanding, there isn't a lot of great evidence for one being much better than the other. In general, in my practice, patients with a spondylolisthesis at L5/S1 always get screws in the back in addition to the ALIF cage but that is because I'm a little more conservative than most.
@@ArmaghaniSpine Dr. Thank you so much for the video and explanation. I am much comfortable about the sugary.
I am 45 female, was a professional volleyball player. I had same condition as that 22 years of patient. L5S1 chronically pars defect with Grade 1 spondylilosthesis.
The Dr. also suggested ALIF plus put screws at the back to stabilized the spine. May I ask would those surgeries complete at the same time? Are those surgeries all minimally invasive surgery. Thanks for your time!
That was the best explanation I’ve heard.
Thank you, Elisabeth!
Thank you so much for your explanation of this surgery.
I’m 41 male and had L4-S1 ALIF surgery on dec 18th 2024, I’m about 13 weeks out and doing relatively well recovering but having so flare ups and bad days depending on on how my day went. I’m in physical therapy and I am seeing progress after each session, but the exercises are strenuous, even though they are easy exercises to perform. My body has become deconditioned. My chief complaint is the fatigue I face day to day, I feel as if it prevents me from achieving even the easiest of tasks sometimes. Sometimes after a walk, errands, PT, light chores I feel as if I ran a marathon. Does anyone else experience this sort of problem who’s has some sort of spinal surgery? Will this feeling go away? I am feel someone down mentally about this. It’s hard to stay focused on essential daily tasks when I feel so tired day to day.
Thank you for your patient oriented explanation.
You are most welcome. It is your body and you must understand what we are doing.
Having this procedure done March 2024, learn alot of information
How did you make out?
Thank you for this informative video. I just found out I will have this procedure on my L5-S1 June 1st in Houston at Methodist hospital. I had a foraminotomy a few years ago and it didn't last long. I'm ready for relief my feet go to sleep when I stand more than a few minutes.
Good luck! ALIF is a great procedure especially following prior spine surgery.
Prayer for your recovery 🙏🏾🙏🏾🙏🏾🙏🏾🙏🏾
How did the fusion surgery go? Success and pain? I am debating the identical surgery.
Hello Doctor! Thank you very much for this video. I'm 12 days post-op ALIF L3/L4 surgery. I had it done because of the DDD and back pain located mainly in back muscles. I didn't have any nerve issues before the surgery, only local pain in lower back. I still feel my old, well-known pain from before the surgery. My surgeon told me that I shouldn't worry about it and it will subside. Could you comment on it somehow? Is it normal to have the same back pain at this point in my recovery process? Best regards!
In general, I tell my patients that for the first month or 2 they will "hate me" because of the pain in their back due to the stretch of the ligaments from putting the cage in. There are good days and bad days during this time. The further they get out from surgery the more good days they will have than bad but full recovery isn't for 9-12 months. So i generally counsel patients that how they feel at 9-12 months will be how they feel long term so it is definitely more of a marathon than a sprint. good luck!
How’s your back doin at around 7 months out? What did your back pain feel like before surgery?
I’m having anterior/ posterior 3 level l4-s1 next month. This surgery really scares me. I’ve had 18 different operations in my life but this one has me trying worried. I have muscular dystrophy so the surgeon wants to put metal rods and screws on the posterior side also for more support. Is this common?
Please do more of these. So informative. I had a decompression and fusion of L2 to S1 plus fusion. That was a year ago. In a lot of pain from the fusion. What can I do. Can a minimally invade correction be done ??
Thank you for your kind words. Visit your surgeon after surgery to ensure that you are fully fused. Not being fused is a common cause, in general, for long-term pain following surgery.
I am having to have this surgery done but in addition to the ALIF my spine doctor is saying I will have to have another surgery the next day or so to put screws in my back. Would you be able to describe what they will be doing in that procedure.
It sounds like a usual "staged" procedure. Sometimes hospitals require cases that require going through the front and the back be split into different days.
Just had this last week and it's so interesting to see how it was done. Great video. Thank You
Glad it was helpful!
@@jaybo516 Much better now but the 1st 3 weeks were rough.
Hello friend how you doing now??
I just has a 2 level lumbar spinal fusion from L3 to L5. My surgeon had trouble placing the cage from a TLIF at L4/L5. I still have significant foramina stenosis at that level and I am wondering if an ALIF would be the best follow up. Is placement of the cage guaranteed with ALIF or might he still not be able to get a cage placed? Or would a better follow up be a decompression?.
How does the range of motion looks like after a fusion at the S1L5 level? What things I wouldn't be able to do anymore?
Doctor thanks so much for the explantion.
Most welcome!
I have an appointment next week. Hope you can help me with my situation.
Thank you! Clear presentation, Extremely helpful
Glad it was helpful!
Why would you choose alif over tilf.
I would like to know myself but I find both scary one is manipulating the spinal cord and one is manipulating the vascular veins and arteries
Thanks doctor. This video was very informative. Is there a greater risk in males when doing this procedure ?
Hi, Marco. There is a very low percentage chance on retrograde ejaculation which could occur (some studies average around 8% in men) which may hurt chances at having children, but this usually does not cause erectile dysfunction. There are additional techniques and precautions we take in surgery that we have learned over the last 20 years or so that lowers this risk even more.
@@ArmaghaniSpine Thanks for responding doctor. That’s exactly what my doctor told me. I’m expected to have ALIF/PLIF and there is a risk in males regarding retrograde ejaculation. But my doctor told me that the risk is pretty low and there shouldn’t be any problems with erections afterwards. I feel better but I’m still worried about the whole surgery itself.
@@marcoriv9016 Did you have the surgery?
@@Besokool Yes. Surgery was done. I had no choice. I was in so much pain :(. Almost no life. I barely started therapy. No complication with surgery. I do hurt some when I walked a lot but the doctor told me that the nerve is very slow to heal. So just keeping positive.
@@marcoriv9016 Thanks for responding. I'm probably going to end up with same type of procedure. If you don't mind, was the recovery really painful? Do you feel like it will be a significant improvement over time? Thanks for any info.
I saw my Neurosurgeon on Thursday and due to severe Spondylolthesis L5/S1, numerous Pars defect, buldging disks, scoliosis. This is the surgery I will be having before the end of this year. Terrified!
0:43 Dr. Armaghani, do you perform lateral/oblique LIF?
This is the surgery I had, they flipped me over to put in the other set of screws. I wished I was on a liquid diet, my constipation was horrible to pass. Had to take a enema on a regular basis, stool softeners don’t work. Excellent videos.
Constipation is certainly something that can occur following this surgery. The reason being is whenever the sack that holds the intestines (peritoneum) is manipulated, it can occasionally take a little bit of time for the intestines to start working correctly again (few days at most). It's almost as if the intestines are "shocked" when they are manipulated during surgery and need some time to feel comfortable to start moving again. I almost always do a mini-bowel prep like you would for a colonoscopy the day before surgery and we try to limit opioids during and immediately after surgery. This has cut down significantly on the constipation issues to the point where I haven't had a problem in a few years now. Thank you for sharing your thoughts and experiences it is invaluable to others.
@@ArmaghaniSpine Thank you, I wished I had known this. Your advice is invaluable.
@@ArmaghaniSpine New development, every time I have to cough I feel pain all the way down my spine. What do you think this could possibly mean? I also have swelling on my back that won’t stay down after icing. I had surgery on Jan 24th, so it’s been 2 weeks so far, I get flair ups if I do to much. I am off Meloxicam cause it’s hard on my stomach. Do you think I might have a bad case of inflammation?
Dr Armaghani I had this procedure last November 2021 and when I came out of surgery my diaphragm was paralyzed and part of my lung was collapsed. Have you ever heard of this. I had to have plication surgery on my diaphragm to get it off my lower lung.
An amazing explanation! Thank you so much!
You are very welcome!
Can you have this procedure on your L4-L5 if you have had a C-section?
Wow Dr your explanations so good 👍 I am speechless
thank you!
Hi Dr i did my procedure last night it went well according the surgeons thanks again for your teaching 😂
Very informative, THANK YOU!
Hello Dr., I have a question I’m having this surgery done December 6, and I was wondering would I be ok having this surgery with a hiatal hernia? Thanks
Is the Alif procedure much prefered when you have already had two surgeries at the same level?
yes at L5/S1 especially. if you can spare the muscles in the back and additional surgery, going anteriorly is ideal in my opinion.
Thank you
Very nice explanation. And easy and clear
please continue
Appreciate the words!
Appreciate the video doc. What are your thoughts on hybrid procedures? I will be going in for a l4-l5 disc replacement and l5-s1 fusion.
Not a lot is published on hybrid procedures but I do, personally, believe that disk replacement is what we are going to be doing in the future much more than fusions.
Im about to jave this surgery but i jave many areas that need surgery, is it normal for them to suggest 1 surgery at a time
In your video state state No bending/twisting/lifting over 20 lbs. So, are you saying that it's ok to do those things without any weight right away? I understand that if so, it needs to be moderate...
Absolutely amazing , everything simplified. Except that shifting/pressing of internal organs in the stomach was pretty scary. You are indeed a great surgeon. Many thanks for the video.
You are very welcome!
Hi Doc, thanks for this excellent presentation. I am not sure if I missed it, but you didn't mention anything about autograft bone that you harvest from other areas compared to the TLIF approach. If I understand right you ony place the cage in the IVD space? Many thanks for your video once more :)
Good question, indeed. We do have to "bonegraft" when doing this approach meaning we have to put something inside the cage to help aid the bones on either side of the disk that we are fusing to send cells across the cage to form a solid fusion. People use a number of different manmade options which don't involve taking any bone from elsewhere in your body which decreases post-operative pain. These are called "allografts" as they come from a source that isn't you. Personally, i like to use bone morphogenic protein-2 or BMP-2 as it's called. This is an FDA approved allograft that improves fusion rates in ALIFs to greater than 90-95% and has been studied extensively over the last 20+ years to the point now that we are very precise in the amount that we put into the cages to maximize fusion rates but decrease any potential negatives which are very rare.
Dr. Armaghani, thank you so much! I am so grateful that I was one of the select patients ALIF was appropriate for. After my fusion, my wife and I are able to fornicate without me experiencing pain.
(the bad kind, that is)
I couldn't recommend you enough!
Thank you so much for your kind words Mr. Knutz!
Thank you very much for your excellent video, I have a question about the fusion procedure, do we lose mobility and/or flexibility with the fusion? I need an L4-L5-S1 ALIF surgery
With an L4-S1 fusion you will notice some loss of range of motion particularly in twisting and bending side to side. Just at L5/S1 or just at L4/5 you wouldn't really notice a difference.
Excellent presentation. Thank you!
Glad it was helpful!
Hi Armaghani, what’s the difference between an orthopedic surgeon and Neurologist surgeon for this type of surgery? I need to do one and I talked to a neurologist friend and he recommended it was better to do it with a neurosurgeon
Thank you for these excellent videos. Your descriptions of anatomy are so helpful in understanding the sources of pain. I will soon have a L4-L5 laminectomy for central and foraminal stenosis and a fusion due to spondolithesis grade 2. Which of your videos might apply to this type of fusion to bring vertebrae into alignment? Your laminectomy video was excellent.
OLIF and TLIF will be the most common surgeries at L4/5. XLIF is basically an OLIF so the video applies. Good luck!
WHAT???
So, you don't use the WILTSE method or midline on the back where you now place the hardware on the 2 vertebrae where you placed the cage to structurally stabilize it?
That's an entirely different surgery called a TLIF. We have a video about it on the page
I think this is the complete knowledge. I wish we staying in a same place. Buy the way sir I'm also suffering from Early degenerative lumbar spondylosis disease so this incision procedure will go on with me?
Excellent video and Excellent information! Thanks very understandable
Glad it was helpful!
Thanks very much for the video! May I ask which method is better Alif or Tlif?
Hello and thank you for the video doctor. Just curious if you can access the nerves from going through the front?
great question. you can partially yes but it isn't something we (or I rather) routinely do. if im doing surgery through the front I am banking on the increase in the space between the bones to be enough to take the pressure off the nerves. About 10-15% of the time it doesn't quite do it enough to the patient's liking and in those situations we go back 6 months later for a small, minimally invasive, outpatient bone removal from the back to make sure nothing is touching the nerve anymore.
@@ArmaghaniSpine thank you so much for the reply. I had a discectomy/laminectomy 8 months ago. Had extremes of back and nerve pain. Over a course of 7 months, I finally got rid of the nerve pain my limiting my movement and diet. Back pain always stuck with me(couldn’t bend). My bottom disc ruptured since then, but never got relief from surgery. My bottom disc is beat up even though I’m 38/male. Got very bad inflammation/ back pain that seems to stem from the bottom disc. The rest of my spine seems to feel unstable since the surgery. Just curious if an alif would be beneficial? I currently haven’t had a quality of life in a year and a half. Your responses are greatly appreciated so thank you again.
Would a fusion be required if you have the disk space but instead have a Grade 1 Spondylolisthesis? While the Grade 1 hasn't increased in years, there is movement from Grade 1 to 0 when laying down. Is this movement normal with a Grade 1 or do some patients keep the Grade one steady between standing and laying down?
some patients do keep the grade 1 steady between standing and laying down. occasionally in older individuals who can't undergo fusions, you can remove bone and free up the nerve on 1 side with good result but doing it on both sides will almost certainly lead to a fusion at some point.