@rita9876 There are some differences between the 2 surgical plans other than the number of levels involved. The ortho surgeon describes fusions from both an anterior and posterior approach. He isn't real specific about exactly what his stage 3 plan is or how many more levels could be involved.

The neuro surgeon recommends ALIF which is anterior approach, and he would achieve deformity correction using osteotomies. This is an over simplification, but basically, they figure out all the geometric angles to correct the curve by taking pie shaped slices of bone from the spine and fusing the spine without those pieces. That can make the foraminae closer together which can compromise the nerve roots unless the surgeon takes that into consideration and may enlarge the foramin if necessary. That would be a question to ask if the nerve roots will have sufficient space and is that likely to change in the years after your spine surgery.

The ortho proposes more hardware and more screws into the spine with rods to support the spine. Both would use rods and screws as instrumentation. The screws needs to be paced at very specific angles so they don't pull out because there is a lot of pressure with body weight at the lower end of the spine. With your osteoporosis and Evenity injections, does that significantly improve your bone density of the spine? Severe osteoporosis can cause a spontaneous compression fracture of the spine and that happened to my elderly mom. It may be worth asking which approach would be a better choice for someone with osteoporosis. Would the extras screws from the orthos procedure be better or worse or cause pressure that could lead to fractures?

The surgeon needs to address what they call sagital balance. Essentially that means that if you drew a center line from your head down your body, your spine should be symmetrical in that sagital plane and not tilted to either side. They also address if the spine is tipped forward or backward in places where it should not be. It is supposed to have a nice S curve. All of this requires correct angles between vertebrae. When you have uneven pressure on the vertebrae, it causes bone growth and remodeling. The neuro mentioned that there is an "autofusion" that needs to be mobilized before it can be fused properly. That is a spontaneous fusion and it might not be lined up in a good way.

The ortho mentions using BMP which is Bone Morphogenic Protein. The neuro may use it too, but doesn't mention it.

Bone Morphogenetic Protein‐2 (rhBMP‐2) has been FDA approved as a bone graft substance in order to increase fusion rates and avoid autograft (taking bone from patient's hip during surgery) harvest. There is some literature that BMP may increase the rate of swelling complications.

Allograft is donor bone that has been cleaned of all the cells, so you have the mineral matrix left that is milled into a shape like a disc for a spine fusion. That is what I have for my fusion at C5/C6.

Both surgeons would include an ALIF (Anterior lumbar Interbody Fusion) which requires a vascular surgeon to be able to move the major blood vessels in front of the spine out of the way, and then move them back after the spine surgeon has finished his work.

The comparison of 20 years experience vs 5 years isn't indicative of the surgeons' capabilities. The question to ask is how many of this particular surgery have they done and what is their personal success rate with it. This is a big surgery that needs a spine deformity expert. Is a surgery with osteotomies preferable to surgery with more hardware with pedicle screws with a history of osteoporosis? Which surgery carries greater risks between the 2 choices? Do you want to get a third opinion? I also look at the surgeons credentials of where they trained, their publications, their areas of interest which needs to match what you need, and if they have won awards or are recognized in their field. Do they also teach their surgical procedures at spine conferences? Does this raise more questions for you?