Revisability of fusions?

[mmglobal]

Allan,

That looks pretty standard except that you don't see the cross bracing in more recent fusions. 4 screws for 1 level, 6 for 2, 8 for 3, etc...

It's not so much about the hardware... it's about he invasiveness of the surgery. Newer techniques strip less muscle away from bone and leave more of the surrounding musculature and ligaments intact.

I almost did 2-level 360 fusion with anterior surgery for cages and posterior surgery for screws and rods. Then, I almost did a 2-level BAK only fusion... anterior surgery with cages, no posterior instrumentation. I believe that the chance of success for that surgery is very low... especially in a tall, active guy... no posterior instrumentation to stabilize???

Now they do STALIF or cages and anterior plates for anterior only fusions that are sturdy enough that no posterior instrumentation is needed. (I don't see anterior plates in the US... maybe they are done, but I don't run into them or doctors that use them.) Or, they'll do PLIF or TLIF procedure to accomplish 360 fusion from posterior only... don't violate the anterior approach. Muscle splitting approaches for posterior only surgeries are great, but you can't gain access to the canal area decompressing very well unless you violate more structures with more invasive access.

Compromises everywhere....

Mark

PS... I'm not a doctor... yada, yada, yada... (I wonder what the people who don't know what yada, yada, yada means think when they read this?)