Anterior Lumbar Interbody Fusion (ALIF)

ALIF

What is Anterior Lumbar Interbody Fusion (ALIF)?

The medical term ‘Anterior Lumbar Interbody Fusion’ refers to a surgical procedure intended to stabilize a painful motion segment in the spine by taking out the problematic intervertebral disc and fusing the unstable or painful vertebral bones.

During this surgical procedure, the neurosurgeon locates the levels of vertebrae requiring fusion through an incision in the front of the belly. The neurosurgeon will then remove the intervertebral disc and place a bone graft in its place to relieve nerve pinching and restore the patient’s height. During the healing process after the surgery, the vertebral bones will fuse into one solid piece. The theory behind every spinal fusion procedure remains that a painful vertebral segment should stop hurting when excessive motion seizes in that area.

What are the Conditions for Anterior Lumbar Interbody Fusion?

A neurosurgeon may recommend Anterior Lumbar Interbody Fusion to a patient with severe low back pain caused by degenerative disc disease. This surgical procedure may also prove helpful to relieve pain in conditions including:

1- Spondylolisthesis

2- Spinal stenosis

3- Scoliosis or Kyphosis

4- Vertebral fractures

5- Persistent spinal instability that has failed to respond to other non-surgical alternatives

A neurosurgeon may not recommend Anterior Lumbar Interbody Fusion for patients with medical conditions that will prevent or prolong bone fusion. These conditions may include severe osteoporosis, obesity, severe atherosclerosis of the aorta, or a significant prior abdominal surgery.

How do Neurosurgeons carry out Anterior Lumbar Interbody Fusion?

A neurosurgeon, with the help of a vascular surgeon, will typically begin Anterior Lumbar Interbody Fusion surgery by making a three-inch to five-inch long incision on one side of the abdomen. The surgeons will then clear a path between the abdominal muscles and blood vessels. This path aims at providing the surgeon access to the spine without cutting through the abdominal muscles. The neurosurgeon will then remove the problematic intervertebral disc and prepare the disc space for the new bone graft. The bone graft material may come from either an organ donor or the patient’s own body. Insertion of the bone graft will then take place after which the surgeon may insert additional screws or a metal plate to keep the graft in place. After the insertion, the surgeon will close and dress the incision to complete the procedure.

What does Recovery from Anterior Lumbar Interbody Fusion look like?

After the Anterior Lumbar Interbody Fusion procedure, a nurse will monitor the respiration rate, blood pressure, and heart rate of the patient. A little pain after this procedure especially at the incision site usually occurs and the surgeon may prescribe pain medications to provide some relief. The patient should take note to make regular body movements some hours after the surgery to avoid blood clot formation in the legs and improve normal circulation.

The surgeon will likely carry out a CT scan the next day to confirm the position of the screws. The patient will typically get discharged after a short period of post-surgical care. Total recovery time usually takes about six to twelve weeks and regular x-ray sessions may occur to confirm a successful fusion.

What are the Possible Risks and Complications of Anterior Lumbar Interbody Fusion?

Just like every other surgical procedure, an Anterior Lumbar Interbody Fusion surgery comes with a couple of risks. Possible complications related to spinal fusion surgeries include bleeding, nerve damage, infection, paralysis, and failure of the vertebral bones to fuse. Specific complications that may occur after the Anterior Lumbar Interbody Fusion procedure include injury to abdominal organs or large blood vessels, retrograde ejaculation, and bone graft migration.

References

Xu DS, Walker CT, Uribe JS. Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med 6(6):104, 2018

Stauffer RN, Coventry MB. Anterior interbody lumbar spine fusion. Analysis of Mayo Clinic series. J Bone Joint Surg Am. 1972;54(4):756-768.

Jackson KL, Yeoman C, Chung WM, Chappuis JL, Freedman B. Anterior lumbar interbody fusion: two-year results with a modular interbody device. Asian Spine J. 2014;8(5):591-598. doi:10.4184/asj.2014.8.5.591

Laratta JL, Davis EG, Glassman SD, Dimar JR. The transperitoneal approach for anterior lumbar interbody fusion at L5-S1: a technical note. J Spine Surg. 2018;4(2):459-460. doi:10.21037/jss.2018.05.18

 

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