Anterior (from the front) lumbar interbody fusion (ALIF) surgery is a traditional spinal fusion surgery technique that helps patients with leg pain from nerve compression, or sometimes low back pain from instability.
The goal of ALIF is to place a large structural cage, either made of bone, titanium or surgical plastic, into the disc space between the bones of the lumbar spine (low back) in order to restore the appropriate height between the discs and realign the spine.
Compared to posterior (from the back) surgery, ALIF’s allow for larger cages and better correction of lordosis (the normal curve of your low back).
By restoring the height of the lumbar spine, your surgeon can decompress your nerve roots and provide stability at the same time.
ALIF is typically performed via a two-surgeon approach, with the general surgeon making a small incision in the abdomen, just below the belly button, and the spine surgeon removing the damaged disc(s) and cartilage and replacing it with the structural cage. Both surgeons are present throughout to maximize safety and efficiency.
Once the incision is made, the surgeons identify the peritoneum, major blood vessels, ureter and psoas muscles and moves them off to the side.
The surgeons then use X-ray fluoroscopy in order to identify the correct disc space.
The damaged disc is removed, along with cartilage, calcified fragments, and bone spurs.
Fluoroscopy is used to ensure that your specific implant is correctly sized and properly positioned.
The structural cage helps stabilize the spine, fill the empty disc space and fuse the vertebrae together. By placing the structural cage at the front of the spine, it allows for indirect decompression and a faster fusion of the spine.
Sometimes, a metal plate is placed anteriorly to provide additional support.
ALIF is frequently performed as a part of a combined procedure, where rods and screws are also placed from a posterior approach during surgery in order to further stabilize the spine during fusion.
This approach is perhaps one of the strongest constructs surgeons can provide to your spine.
ALIF surgery allows for decompression of your nerve roots indirectly by rebuilding lost disc height, which frequently occurs with aging and arthritis.
By removing degenerated discs, a large, tall cage can be placed to achieve normal disc height and therefore take pressure off your nerve roots.
In instances of instability, or spondylolisthesis (slip), it provides immediate stability with a large bone graft, strong plate, and achieves very high fusion rates (>95%).
Lastly, it is a great procedure to reestablish lordosis, or your normal curve that is frequently lost with aging and arthritis.
Because the spine is accessed anteriorly, there is less muscle disruption, and frequently less pain post-operatively.
Furthermore, larger cages can be placed from an anterior approach when compared to posterior, allowing for greater lordosis, more robust constructs, improved restoration of height, and very high fusion rates.
Recovery and prognosis from a single-level ALIF are typically quite rapid.
Most patients are able to leave the hospital within 24 hours of surgery.
ALIF is typically a non-invasive surgical approach with very minimal post-surgical abdominal pain.
When ALIF is used in a multi-stage approach with a larger incision, recovery may be longer.
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