Anterior Lumbar Interbody Fusion

ALIF is a surgical technique where Dr. Colman and an access surgeon (typically a general surgeon) makes an incision in the abdomen to access the lumbar spine. The intervertebral disc, which is the cushion between the vertebrae, is removed, the spine re-aligned, and a bone graft or an interbody cage is placed between the vertebrae to promote fusion. This fusion process involves the growth of new bone, which eventually joins the vertebrae together, creating a solid and stable spine segment. This procedure is commonly used to treat a pinched nerve in the lumbar spine that causes pain, numbness and tingling.

ALIF is typically indicated for patients with certain conditions that have not responded to conservative treatments for at least 6-8 weeks of physical therapy, medications, or injection. These conditions include:

• Degenerative Disc Disease: Intervertebral discs degenerate, causing chronic back pain.
• Spondylolisthesis: A condition where one vertebra slips over the one below it.
• Spinal Stenosis: Narrowing of the spinal canal or neuroforamina can compress nerves and cause pain.
• Multiple Herniated Disc: When a disc ruptures and its inner material presses on nearby nerves, especially when this has been treated and failed with multiple prior surgeries
• Pseudarthrosis: When prior spinal fusion does not heal properly, ALIF can be a very reliable way to correct the deformity
• Adult deformity: ALIF can be a very powerful method of correcting adult spinal deformity

The ALIF procedure generally involves the following steps:

1. Incision: A horizontal or vertical incision is made in the lower abdomen to access the spine.
2. Exposure: The surgeon carefully moves aside abdominal muscles, organs, and blood vessels to reach the spine.
3. Disc Removal: The damaged intervertebral disc is removed, creating a space between the vertebrae.
4. Spinal re-alignment by establishing normal disc height and angulation
5. Insertion of Graft/Cage: A bone graft or an interbody cage filled with bone graft material is placed in the disc space to maintain disc height and promote fusion.
6. Stabilization: Screws and rods may be used to further stabilize the spine, depending on the individual case.
7. Closure: The incision is closed, and the patient is taken to recovery.

ALIF offers several important benefits:

• The anterior approach provides direct access to the discs without disturbing spinal nerves or exposing scar from prior back surgery
• It allows for the placement of relatively large spacers, which can enhance stability and the chances of successful fusion.
• The procedure typically results in less blood loss compared to posterior approaches.
• There is less muscle displacement which contributes to faster recovery.

Generally, risks for anterior lumbar surgery are low. Commonly cited risks include persistent pain or failure to heal with bony fusion after surgery. Fortunately, these risks are quite rare (<5%).

Adjacent segment disease (breakdown of discs above or below the surgery) is thought to occur at a rate of 2-3% per year after fusion.

More serious risks such as bleeding, blood vessel injury, abdominal organ injury, retrograde ejaculation in males (painful and ineffective ejaculation), and medical risks of anesthesia and surgery are exceedingly rare, fortunately.