Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Is XLIF Safe To Have For Chronic Back Pain?
Question: hello,
I've asked about my back before.but I have new information and a new x-ray to share. at my first visit with my ortho he was hesitant at my age (37) to talk about doing the XLIF. said it would be a last resort, even though I'm not a typical 37 year old since I've had gastric bypass and lost 210lbs and kept off 175. looking at my MRI he said I basically have no discs from L3 down. I've been living with back pain as long as I can remember. I've been doing physical therapy on and off for years, I just had my first steroid shot, pain management is the only thing I haven't don't because my pcp and ortho think it makes everyone a junkie, but at my follow up for the shot he ordered xrays. my PCP has been treating it conservatively for years. anyway when he pulled up the xrays he was shocked and didn't know how I could even function with that much damage. I'm so scared of a fusion but if it will work and the only option left. I suppose my question is at my age will I need more down the line? I've heard it puts pressure on the discs above and below the fusion site. I'm just looking for answers and support everywhere I can think of. thank you.
I've asked about my back before.but I have new information and a new x-ray to share. at my first visit with my ortho he was hesitant at my age (37) to talk about doing the XLIF. said it would be a last resort, even though I'm not a typical 37 year old since I've had gastric bypass and lost 210lbs and kept off 175. looking at my MRI he said I basically have no discs from L3 down. I've been living with back pain as long as I can remember. I've been doing physical therapy on and off for years, I just had my first steroid shot, pain management is the only thing I haven't don't because my pcp and ortho think it makes everyone a junkie, but at my follow up for the shot he ordered xrays. my PCP has been treating it conservatively for years. anyway when he pulled up the xrays he was shocked and didn't know how I could even function with that much damage. I'm so scared of a fusion but if it will work and the only option left. I suppose my question is at my age will I need more down the line? I've heard it puts pressure on the discs above and below the fusion site. I'm just looking for answers and support everywhere I can think of. thank you.
Brief Answer:
Consultation
Detailed Answer:
Hi XXXXX, thanks for asking from HCM.
I can understand your concern. You have been planned for extreme lateral inter body fusion (XLIF). There must be dangerous spinal instability thats why it has been planned. XLIF is a good method to fuse spine as it does not cut normal spinal ligaments (anterior and posterior longitudinal ligaments).
It is usually indicated for thoracic-lumbar spine disease. As you have already mentioned, you are having problem above L3. I do not know exact diagnosis as it has not been mentioned, but spinal instability/listhesis above L3 can be treated by
XLIF.
Surgery is always last resort. You will not need anything beyond it if it is planned according to your disease. Success rate of XLIF is
Fusion around 90-100%
40-80% reduction in pain
40-82% reduction in disability
So you can go for it.
Regarding complications, there are many complications which can occur
Persistent pain/continued pain after surgery
Infection
Failure to fuse (pseudoarthrosis, or non-union)
Muscle weakness
Vascular injury (injury of the blood vessels like abdominal aorta/inferior vena cava
Neurologic injury (nerve or spinal cord damage)
Urinary tract infection
Stroke
Pneumonia
Deep vein thrombosis (clotting) due to immobilisation
Spine instability or chances of disc disease increased, above and below fusion level. You already know it.
All these can be decreased by taking precautions and understanding them before.
You have to follow few tips
: Start breathing exercise
: Reduce weight
: Make bone stronger by eating healthy calcium diet, vitamin D diet like meat, egg
: Do exercise of lower limbs to increase venous drainage
: Maintain hygiene
Hope it will help you. If still in doubt, let me know.
Thanks. Take care.
Consultation
Detailed Answer:
Hi XXXXX, thanks for asking from HCM.
I can understand your concern. You have been planned for extreme lateral inter body fusion (XLIF). There must be dangerous spinal instability thats why it has been planned. XLIF is a good method to fuse spine as it does not cut normal spinal ligaments (anterior and posterior longitudinal ligaments).
It is usually indicated for thoracic-lumbar spine disease. As you have already mentioned, you are having problem above L3. I do not know exact diagnosis as it has not been mentioned, but spinal instability/listhesis above L3 can be treated by
XLIF.
Surgery is always last resort. You will not need anything beyond it if it is planned according to your disease. Success rate of XLIF is
Fusion around 90-100%
40-80% reduction in pain
40-82% reduction in disability
So you can go for it.
Regarding complications, there are many complications which can occur
Persistent pain/continued pain after surgery
Infection
Failure to fuse (pseudoarthrosis, or non-union)
Muscle weakness
Vascular injury (injury of the blood vessels like abdominal aorta/inferior vena cava
Neurologic injury (nerve or spinal cord damage)
Urinary tract infection
Stroke
Pneumonia
Deep vein thrombosis (clotting) due to immobilisation
Spine instability or chances of disc disease increased, above and below fusion level. You already know it.
All these can be decreased by taking precautions and understanding them before.
You have to follow few tips
: Start breathing exercise
: Reduce weight
: Make bone stronger by eating healthy calcium diet, vitamin D diet like meat, egg
: Do exercise of lower limbs to increase venous drainage
: Maintain hygiene
Hope it will help you. If still in doubt, let me know.
Thanks. Take care.
Above answer was peer-reviewed by :
Dr. Yogesh D
thank you very much for the pre op tips. I've been trying to find info on that too. I have almost too many issues to list. DDD, DJD, Spondyloslisthesis, lordosis. I have literally no disc at l3.l4 then major degeneration at L4-L5 and L5S1. obviously can't do L5S1 with XLIF. but he's hoping it will stabilize it enough to relieve the pressure. I guess my last question is why is my age such a concern? Will eventually need more surgery as I've read fusions put more pressure on the discs above and below. or should this be it. I have 5 and 7 year girls left at home so I'm also worried about recovery.
Brief Answer:
Consultation
Detailed Answer:
Hi, thanks for asking.
Answering your first question
Your age is a concern, because you are young. You have a long life to live actively. Fusion of spine at this age will result in immobility and decrease in functioning.
Second this fusion will result into more degeneration and load bearing on level above and below. It is true that you will be having higher risk of disc degeneration after spinal fusion. But don't worry, it is not that much common and if you will follow few tips strictly, chances will become lesser
: After fusion and postoperative recovery, start exercise under supervision of physiotherapist. Strengthen your back muscle to bear load and thus put less pressure on spine.
: Avoid alcohol and smoking as these damage bone (spine).
: Avoid forward bending, prolonged sitting or standing. You can walk.
: Avoid weight lifting. It will increase chances of lumbar disc
: You can use "dorso-lumbar corset" while travelling, working. Do not wear it more than 8 hours in day. Excessive use of it can cause weak back muscle. I am advising it to you to prevent jerky movement over back.
: Regular follow up of your treating surgeon to detect further degeneration at an early stage.
Do not worry about your daughter's future. I assure you, you will be having no complaints in future if you will follow above tips and your doctor's advise.
Hope it will help you. Thanks, take care.
If still in doubt, I will be happy to help you.
Consultation
Detailed Answer:
Hi, thanks for asking.
Answering your first question
Your age is a concern, because you are young. You have a long life to live actively. Fusion of spine at this age will result in immobility and decrease in functioning.
Second this fusion will result into more degeneration and load bearing on level above and below. It is true that you will be having higher risk of disc degeneration after spinal fusion. But don't worry, it is not that much common and if you will follow few tips strictly, chances will become lesser
: After fusion and postoperative recovery, start exercise under supervision of physiotherapist. Strengthen your back muscle to bear load and thus put less pressure on spine.
: Avoid alcohol and smoking as these damage bone (spine).
: Avoid forward bending, prolonged sitting or standing. You can walk.
: Avoid weight lifting. It will increase chances of lumbar disc
: You can use "dorso-lumbar corset" while travelling, working. Do not wear it more than 8 hours in day. Excessive use of it can cause weak back muscle. I am advising it to you to prevent jerky movement over back.
: Regular follow up of your treating surgeon to detect further degeneration at an early stage.
Do not worry about your daughter's future. I assure you, you will be having no complaints in future if you will follow above tips and your doctor's advise.
Hope it will help you. Thanks, take care.
If still in doubt, I will be happy to help you.
Above answer was peer-reviewed by :
Dr. Deepak
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
