[ NEWS - SPINE ]
Tim Rasmusson , M . D . I ’ m an access surgeon . Is that a bad thing ???? Ryan DenHaese , M . D .
Bayram Cirak , M . D .
Jake Timothy , M . D .
Tim Rasmusson 14k approaches and counting ! My man ! Ryan DenHaese , M . D . ok 10k ALIF and rest LLIF … but who ’ s counting LOL . IMO … ALIF and LLIF are the best surgeries we do in Lumbar spine . Single level ALIF …. One of best surgeries we can do . Tim Rasmusson has done over 10k approaches for ALIF and published this data with limited Morbidity
Posterior is always better , safer and easier both for patients . And surgeon . In case anterior fusion is a Must AxiaLif is a choice .
There is no doubt an ALIF is a superior fusion procedure and created more lordosis . A lateral ALIF is even better . I regularly back up posterior , my question is this really necessary or will a standalone ALIF ( with integrated screws ) suffice .
Simon Sandler , M . D . Standalone for almost everything .
Mike O ’ Neill , M . D .
Ioan Branea , M . D .
1 . 360 always for lytic spondy . 2 . Think about 360 with degen spondy and high sacral slope / domed sacrum .
Cunningham & Cappuccino et . al found standalone ALIF w / 3 screws was equivalent to 360 A / P w / ISOLA pedicle screws ; and superior to Anterior Plate + IBD . No difference between 3 screw vs 4 screw stand-alone constructs . No posterior tension band looks pretty awesome considering it avoids the incidence of facet impingement and subsequent adjacent level disease . What is more MIS than zero posterior muscle disruption ? What low back surgery would surgeons do on themselves or a loved one ?
To say that with ALIF there is no possibility of direct neural decompression is the same as to say one cannot decompress the cord or cervical nerve roots with ACDF
Tanyo Hristov , M . D . Ioan Branea True ! Feasible even in recurrent herniations . Francis Kilian , M . D .
We in Germany are used to perform the anterior approaches by ourself — but in difficult cases — revisions I always contact our vessel surgeons and we plan the intervention together . The risk of neural complications is higher by XLIF .
Michael Coroneos , M . D . Yes , with lateral approaches the vessels and ureter may not be seen until traumatized . Chaunchao Du , M . D .
Puya Alikhani , M . D .
Samir Smajic , M . D .
Andrew Vivas , M . D .
Ray Ross , M . D .
I really enjoy the post and discussion here , I think the main reason for the popularity of the poster approach is repeatability , low complication of big vessel or nerve injury , then is the insertion of Pedicle Screws . The advantages of anterior approach far surpass the posterior approach from the viewpoints of biomechanics . As for decompression , it can be well achieved with the assistance of the endoscopy .
Although a great surgery , it comes with its own risks , I have seen increased risk of DVT and foot drop due to over distraction in addition to risks mentioned by Dr . Juan Uribe , M . D .
Which is easier : teaching an access surgeon how to perform an ALIF or teaching a spine surgeon how to perform an anterior access to L5 / S1 and L4 / 5 ? That ' s why I prefer to perform my own accesses . The real skill lies in mastering the anterior access technique and taking responsibility for the patient , even if it means forgoing an ALIF .
Dr . med . Samir Smajic I think there are many surgeons in the US ( myself included ) that would gladly do their own access , especially for straight forward cases . However , the medical-legal climate in the US is such that we cannot . Any complication would be very high risk of a lawsuit .
Retrograde ejaculation and ALIF Did you check on status pre-surgery ? Did you use diathermy when you identified the sacral artery and vein ? That ’ s a no . Did you identify filaments of the pre- sacral plexus and sweep them to one side with a peanut before you opened the annulus ? indirect neural decompression is achieved by disc height restoration and entering the epidural space to remove posterior annulus any extruded disc material or osteophytes ( rare because if a disc has reached this degree of degeneration it will be very stiff and restoration of disc height nearly impossible ) I agree revision through scar is a tour de force . But under what circumstances are you forced to do that ? If nonunion of ALIF ( rare ) just fuse posteriorly . Infection massive issue but fortunately rare . Post disc replacement fuse posteriorly but I ’ ve converted several to fusion - for revisions best to have a very experienced vascular surgeon doing the approach . You might have to divide the left common iliac vessels to gain safe access to 4 / 5 but they can be rejoined successfully like any sizeable blood vessel . Most of your issues can be minimized or overcome .
22 - RYORTHO . COM