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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Profile picture for kdks99 @kdks99

@annie1 If you are comfortable using AI you can get a lot of information about international surgery. Surgeon's here are more comfortable with fusion and probably do too many. because of familiarity and reimbursement. If you live near a major teaching hospital you can probably find docs who make more individualized surgical plans.

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@kdks99
Actually I live near many major teaching hospitals in New York City and I find the opposite is true they seem to not want to do anything very different all of them are saying fusion except one woman who said I should not have fusion she didn't think it would help me but you didn't have anything else to offer for me except physical therapy that has no effect on my symptoms and she told me to try acupuncture which also had no effect did not help I tried it with several different acupuncture. So I am at a loss for where to go that's why I thought maybe in Europe since they do less fusion that I have no clue as to where to go and what country they would speak English. I was in Spain and had a very rude wake up call that hardly anyone wanted to speak English to me and it was very difficult.

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Profile picture for gently @gently

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

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@gently
None of the surgeons I have spoken with have offered artificial disc replacement. They only offer fusion. Today I saw the head of surgery at Mount Sinai in New York and he said he would do a posterior incision only. I don't know if that would include any kind of artificial disc that I can ask him. The other thing that bothers me is that when I asked him about any complications in any of his past surgeries he said he only had one infection years ago and no other complications. I find that hard to believe and I couldn't think of anything to say to that. He's a very gentle, likable man with excellent credentials but do you think I should keep asking him are you sure you've never had any complications at all in any of your fusions?

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Profile picture for annie1 @annie1

@kdks99
Actually I live near many major teaching hospitals in New York City and I find the opposite is true they seem to not want to do anything very different all of them are saying fusion except one woman who said I should not have fusion she didn't think it would help me but you didn't have anything else to offer for me except physical therapy that has no effect on my symptoms and she told me to try acupuncture which also had no effect did not help I tried it with several different acupuncture. So I am at a loss for where to go that's why I thought maybe in Europe since they do less fusion that I have no clue as to where to go and what country they would speak English. I was in Spain and had a very rude wake up call that hardly anyone wanted to speak English to me and it was very difficult.

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@annie1 Believe the experts. My expert fixes other doctor's replacement disk problems and they are very serious with potential paralysis. During the surgery, he is obligated to do a fusion anyway.

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Profile picture for gilkesl @gilkesl

@annie1 Believe the experts. My expert fixes other doctor's replacement disk problems and they are very serious with potential paralysis. During the surgery, he is obligated to do a fusion anyway.

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@gilkesl
Ok so who is your Dr and you are saying that replacement disc is not very safe?

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Profile picture for htolan @htolan

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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@htolan
Can you please resend me the name of the surgeon? I think you have to send it privately to me on the Mayo connect. Thank you so much

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Profile picture for annie1 @annie1

@htolan
Can you please resend me the name of the surgeon? I think you have to send it privately to me on the Mayo connect. Thank you so much

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@annie1 how do I send it privately?

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Actually I found the old post and you sent me his name. Tyler is the first name. So you have osteoporosis or had it at the time of your fusion? And everything worked out okay? In terms of sending things privately I figured it out a while ago but right now I'm just getting up I'll try to coach you through it another time. Thanks

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