Understanding surgeon speak and the different approaches to fusion

annie1, the difference in these techniques is about where the surgeon accesses the disc. You might want to consider artificial discs, if you haven't.
https://www.spine.md/artificial-disc-replacement/disc-replacement-vs-spinal-fusion/
transforaminal lumbar interbody fusion https://www.youtube.com/watch
anterior lumbar interbody fusion https://www.youtube.com/watch
extreme lateral interbody fusion https://www.youtube.com/watch

Thanks for your answer. None of the surgeons I have spoken to think I am a candidate for an artificial disc replacement. They all want to do mega surgeries except possibly one that I'm waiting to hear back from from the Cleveland clinic who uses tops. The rest have told me I need a very big surgery, ALIF or TLIF
Have you had spine surgery and if so what did you have done?

annie1, I'd just posted these video links to a cousin. She will be on Forteo another 3 months before surgery, https://pmc.ncbi.nlm.nih.gov/articles/PMC4522448/ for a total of ten. She is having a difficult time with pain, meanwhile.
There are few surgeons( https://www.adrspine.com/resources/press/80-spine-surgeons-performing-artificial-disc-replacement-2024) experienced with artificial discs. The scary part is that surgeons that have this skill and training are eager to practice and those that don't have the training, recommend the type of surgery they are most skilled at.
I have no experience with any of the surgeries. I am having a good experience with Forteo.
Bless your choices with the best luck.

I too have osteoporosis and scoliosis. I'm not in need of a fusion but I have never thought of the potential complications associated with all 3 in the same patient. Thank you for starting this discussion.

I know some people really need a fusion but in trying to make a decision about my own situation I found this interesting. I use AI to gather information. This is just an FYI obviously not relevant to anyone's specific situation.
• Utilization gap: Historic and current data show the U.S. performs far more back surgeries/fusions than Europe; drivers include payment, practice norms, medico-legal climate, and technology diffusion; watchdog analyses (e.g., Lown Institute) continue to flag overuse in Medicare.

WHEN FUSION IS INDICATED — EUROPEAN GUIDELINES

✅ Yes, consider fusion if:
- Unstable spondylolisthesis (symptomatic)
- Isthmic spondylolisthesis
- Loss of sagittal balance (deformity)
- Bilateral facetectomy >50%
- Adult scoliosis with stenosis
- Recurrent stenosis with instability

❌ No, fusion not needed if:
- Stable spine
- Only leg pain (no instability)
- Back pain without mechanical pattern
- Normal alignment
- Facet arthropathy alone

I do have two of those things but I was told my spine is stable during a radiology exam however the surgeons say my spine is unstable. Who do I trust ?

@annie1 you should trust your surgeon and if you don’t feel comfortable with them find one who you do feel good about. You don’t say what your concerns are regarding the different types of approaches and maybe we could help you more with that information? Just having osteoporosis alone should not keep you from a beneficial procedure if you’re in pain. The doctors would not consider operating on you if osteoporosis was an issue.

@jenatsky I have osteoporosis and scoliosis and had back fusion 8 weeks ago. I went to Northwestern and their neurosurgeon who specializes in deformed spines did a great job. I am 72 and doing well.
I trusted him completely. My pain is so much less than before surgery.

That is fantastic to hear that your surgery fixed whatever issue your back had. If you exercise don’t ever stop and if you don’t please start.

@htolan
This thread is confusing. Is it you that had surgery at Northwestern ? Can direct message me the name of the surgeon please ? Also, what did your pain feel like ? Mine is throbbing in my calf muscles and sometimes in my groin and also right thigh and hip ache. Not many people seem to have the throbbing pain.