Understanding surgeon speak and the different approaches to fusion

Posted by annie1 @annie1, Oct 14, 2025

I have consulted many surgeons because I have serious concerns about having fusion since I have osteoporosis. I found out there are at least four types of fusion and I would like to understand them better and what would be the best for me. Can someone elucidate on TLIF, ALIF and XLIF ?

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I’m having some issues from the surgery that are probably due to my age, 72. Other than that, I am doing quite well at 2 months. I have the usual restrictions, don’t bend, don’t twist and don’t lift over 8 pounds, but I am quite pleased with my progress.

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I had the same problem with my pain med doctor. I did not understand half of what he was saying.
I did 2 things.
1- I talked to the PA for my doctor. She was excellent in explaining the options I had and what the doctor would do in the surgery to correct them. If your doctor has a PA or APRN make an appointment with them
2- I went on the patient portal and downloaded his summary of my problem and solutions. Yes it was mostly medical terms but I went on line and looked up just about every word.

hope that helps you

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Profile picture for jenatsky @jenatsky

@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.

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@jenatsky
This thread is a bit old, but I will look up that Doctor a Northwestern. There are risks to having fusion with osteoporosis. One surgeon told me he was wary of working with me but others haven't. Were you on medication for Osteoporosis for a few months before the surgery ?

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I had my surgery in 1990 after falling in 1988. I was much younger and it was doubtful I had OP at the time. I’ve been offered to switch my stainless steel bars for titanium but at 73 without a need I’m not doing surgery again.

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Profile picture for htolan @htolan

Yes, I had surgery at Northwestern with Dr. Tyler Koski. My pain prior to surgery was all kinks, throbbing, stabbing, aching…It was in my back, hips IT Bands and quads. With a walker I had trouble walking. It had been getting worse in the last few years.

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@htolan
I can't remember if you said you had osteoporosis. Please let me know. Thanks

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Yes, I do have osteoporosis and osteoarthritis.

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Profile picture for htolan @htolan

Yes, I do have osteoporosis and osteoarthritis.

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@htolan
Well I'm trying to figure out if it was you that saw the doctor at northwestern and it was a successful fusion and if you had osteoporosis when you have the surgery.

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Yes, I had scoliosis fusion at Northwestern and I am considered osteoporosis because I have had so many fractures. Following a CAT scan, my doctor said my spine looked good enough to do the surgery. I believe parts of my body are worse than others as far as my bones go.

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Has anyone had nerve blockers ? My doctor says we should try this for L4 L5 S1. Had cortisone shot which caused a worse pain as it was happening- the pain that was worse in the calf that day shot down the leg, up to the thigh and then returned to the calf worse than ever. Had cortisone with epidural and no better. Now going to give nerve blocking a try. Opinions please?

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Profile picture for carolinec @carolinec

Has anyone had nerve blockers ? My doctor says we should try this for L4 L5 S1. Had cortisone shot which caused a worse pain as it was happening- the pain that was worse in the calf that day shot down the leg, up to the thigh and then returned to the calf worse than ever. Had cortisone with epidural and no better. Now going to give nerve blocking a try. Opinions please?

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@carolinec
I am going to ask for a nerve block also. The epidural didn't do much. Good luck to us both !

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