another doc, another opinion... anyone know much about MIS TLIF???

[laid up doc]

i posted before about my consternation about what to do about my crappy L5/S1 disc... well I went to NC to see a neurosurgeon who came highly recommended - this is my hometown and where I have more support should I have surgery, compared to where I live now. plus it's a LOT cheaper than the DC metro area.

he had 2 thoughts: 1. he wants to talk to the guy in his group who does ADR (Dom Coric, who i think other here have used), 2. if not a candidate for ADR, he'd do a minimally invasive TLIF (transforaminal).

i've reviewed some literature, and it seems fusion rates are comparable for ALIF vs TLIF. the MIS part is that they use serial dilators to access one foramen and to the interbody fusion from that angle.

saw another ortho in Charlotte who is one of the old school "haters" I call them - will look at your MRI only, don't believe in discograms/discogenic pain, and refuse to give you any options b/c your MRI doesn't look bad enough. wish i had known that in advance what a waste of time.

am seeing one more ortho here in DC... then i gotta fish or cut bait, at least in terms of where i live... no more job as of early Sept. i am "prn" and they hired some new FT folks, so no more "n". plus, what i'm doing is just spinning my wheels... daily TENS unit for hours and hours, ambien/trazodone to sleep more than 2 hrs. etc etc...

[laid up doc]

anyone? bueller?

trying to get this metal allergy thing sorted out. attempting to get in w/ a dermatologist who specializes in this sort of thing, occupational derm and metal allergies. i reviewed some literature about metal testing too, and patch testing appears to be the initial step. here's a link to an emedicine article about implants and skin allergies, though they don't specifically mention ADR's:

Medscape: Medscape Access

[annapurna]

Weird take on the metal allergies: any chance you have high but sub-critical levels of metals in your system already? Laura was tested and found to have much higher levels of chromium in her system than she should have. She did a little bit of chelation but hasn't had the opportunity to see if it dropped the levels.

[laid up doc]

prodiscs contain chromium, and they're known to leach ions - see the abstract i posted in my previous posting in this subforum.

the prospect of having metal in my body that can't come out is horrifying b/c of my h/o atopy to just about anything.

[annapurna]

Originally Posted by laid up doc

prodiscs contain chromium, and they're known to leach ions - see the abstract i posted in my previous posting in this subforum.

the prospect of having metal in my body that can't come out is horrifying b/c of my h/o atopy to just about anything.

No, I meant that I wondered if you might have high levels in your system now, before any implant.

Laura's high chrome levels have more to do with poor lab practice in her days as a grad student rather than leaching from implants.

[laid up doc]

don't have any reason to think i would... no neuropathy or cognitive problems, no exposure. just med school and residency - where i was more at risk for blood-borne illnesses from needlesticks/crazy or very sick people not in control of their blood/secretions, and TB, (bc of where i trained) than anything else!

why did anyone check a chromium level in the first place? the only time i ever ordered heavy metals levels was in med school, working up pts w/ dementia for reversible causes.

[Maddie]

Can you explain the discussion on this thread? It started out with the difference in the two surgeries, correct? Then went off to metal allergies.

I had both an ALIF and XLIF done just over a year ago, and the ALIF was a much more significant surgery than the XLIF. I had an ADR done at my C5/6 at the same time as well. It took a lot longer to heal with the first one. I have no experience with the TLIF though. Not sure that helps

The lymphocytes are then mixed with solutions of specific metal ions, such as nickel, chromium, cobalt, or titanium.

This part sounds similar to the metal allergy testing I had done before surgery, and it disclosed that I am severely sensitive to cobalt, chromium, iron, aluminum and off the charts with nickel. Each of those are found in one form or another in most ADRs. If I had surgery before discovering this, I have little faith that any doctor I could see here would have discovered the root of the problem, and the reaction would most likely have done me in eventually.

I was stunned to learn that I was sensitive to so many metals. While always having had reactions with cheap jewellery, I just started having problems with other various allergies about three years ago, and did the blood test just in case.....

I have been a visual artist since I was a young child, mainly oil, pastel and watercolour paintings, and these metals are also on the ingredient list of most paints I use. I'm just assuming that this is the connection, but I'll never know.

[Mark Kim]

I am in the same predicament where the neurosurgeon offered to do a MIS TLIF. I was also offered other types of surgeries such as the ALIF and PLIF. The neurosurgeon I visited, liked the MIS TLIF because based on his experience he has not seen anyone come back to him about the adjacent levels being effected from the fusion. This is just based on his observations and not anything in the research literature. He didn't like the ALIF because of all the side effects that come along with it especially for males.

I like the idea of MIS TLIF because it preserves a lot of the structure and cut very few muscles whereas open fusions like the PLIF require a lot of dissection. I am not a medical professional but this was all explained to me by the numerous consults I have been on.

[laid up doc]

Maddie -

i think the reason it got back to metal allergies is that if i have non-titanium allergies, i would be willing to have a fusion knowing that the screws come out if a problem developed. not really an option for an ADR.

also, something i didn't really detail is that my insurance (Aetna) covers ADR but per their policy doesn't cover fusion for discogenic pain. so, makes a big difference in the what i would have done and how i'd get it covered. i am at least allergic to nickel per my history, which has cross-reactivity w/ chromium. have a titanium tooth implant which has caused no problems.

have to talk to Dr Coric's nurse again, but apparently whatever he'd use is titanium - maybe he has an ability to get a study disc under an exception? b/c prodisc and charite both have cobalt/chromium alloys. studies for new discs (comparison to prodisc) all state an exclusion for allergies to cobalt, chromium, molybdenum, or titanium. looks like activ-L may not have chromium? site says "End plates are either spiked or keeled and are coated with both titanium and calcium phosphate". can't find on the web what the in motion (charite replacement) is made of - but i have an industry rep friend who can probably help me w/ that.

i did a search and didn't see a lot of posts for better or worse about MIS-TLIF, and nothing recent. in my mind they went together, but i made a jump in my head that i didn't articulate. just so scared to make the wrong decision, since either surgery is not reversible, and ADR isn't removable. i can't imagine how overwhelming it is to make medical decisions when one isn't a medical professional... i'm a type A nerdy MD (not a surgeon) and this stuff is making me batty!

[MeggieLynn]

Don't know if you'd be interested in this, but the Depuy online spine center website has a series of videos showing how a MIS-TLIF surgery is performed.

Video: MIS TLIF

ML