Anterior Lumbar Interbody Fusion
An Overview
Anterior lumbar interbody fusion, often abbreviated ALIF, is a type of spine surgery performed to treat low back disorders including degenerative disc disease (DDD) and spondylolisthesis. DDD and spondylolisthesis are examples of spinal problems that may compress spinal nerves and cause instability. Compression or pinching of nerve structures may cause low back,
buttock and leg pain. Other neurologic symptoms may include numbness, tingling and weakness in one or both legs. The goal of an ALIF procedure is to decompress the nerves, stabilize the lumbar spine, relieve symptoms, and enable the patient to return to regular activities of daily living.
Anterior = front
The surgical incision is made in the abdomen (eg, stomach area) usually on the left or right side.
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Lumbar = low back
The lumbar spine is one region of the spine. There are five vertebral bodies in the low back; numbered L1 (top) through L5 (bottom). The disc levels are also abbreviated. For example, L3-L4 refers to the intervertebral disc space between the third and fourth lumbar vertebral bodies (bones).
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Interbody = between twovertebral bodies
The interbody space is the disc space.
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Fusion = to join or combine
Bone graft is inserted into the empty space between the upper and lower vertebral bodies. Instrumentation (eg, cages, plate, screws) is implanted to immobilize (stabilize) the low back. The body’s natural healing processes cause new bone to grow into and around the instrumentation resulting in a spinal fusion.
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Not every patient with lumbar degenerative disc disease or spondylolisthesis requires spine surgery. ALIF may be recommended for the following reasons: non-operative treatment fails to relieve symptoms, progressive worsening of neurologic symptoms or pain, spinal instability, and/or neurological problems. Numbness, loss of function, and weakness are examples of neurologic dysfunction.
About the ALIF Procedure
Anterior lumbar interbody fusion is performed under general anesthesia. The low back area is cleansed and prepared for surgery. The size of the incision depends on the number of spinal levels to be treated and whether the surgery is open (3- to 5-inch incision) or minimally invasive (one or a few tiny incisions).
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The entire remaining diseased disc is removed out to its borders. The height of the disc space is restored and nerves are unpinched. A spacer is filled with bone graft and inserted to maintain the restored alignment of the spine and to allow for fusion.
Pre- and post-operativeimages of benefit:
Sometimes, an ALIF procedure is combined with posterior instrumentation. Posterior fusion means the instrumentation (screws and rods) are implanted in the back of the spine.
Types of Bone Graft:
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Autograft is the patient’s own bone; usually taken from the hip.
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Allograft is donor bone from a bone bank.
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Bone graft substitute; there are different types, some of which are synthetic (man-made) and available in different shapes.
After Surgery
After surgery, the patient is moved into the recovery area. In recovery, nurses and other members of the medical team closely monitor the patient’s vital signs – pulse, respiration, blood pressure, and pain. Some post-operative pain should be expected and patients receive pain medication either through their IV (intravenous line) or by mouth. Dr. Akamnonu discusses the likelihood of hospitalization with patients before their surgery date.
After Care at Home
ALIF patients recieve information about what to expect and self-care after hospital discharge. This information includes instructions to control pain, medications, diet and managing constipation, bathing and incision care, activity restrictions, and the surgical follow-up appointments