What Is An ALIF?
Anterior lumbar interbody fusion (ALIF) is a type of spinal fusion that utilizes an anterior (front – through the abdominal region) approach to fuse (mend) the lumbar spine bones together. Interbody fusion means the intervertebral disc is removed and replaced with a bone (or metal) spacer, in this case using an anterior approach.
The anterior technique is often favored when multiple spinal levels are being fused and multiple discs need to be removed. ALIF may be performed in conjunction with or without a posterior decompression (laminectomy) and/or instrumentation (use of metal screws/rods). The anterior ALIF approach is also ideal when only one spinal level is fused and a posterior decompression and/or instrumentation are not required. Although the anterior lumbar ALIF approach involves retracting (moving out of the way, temporarily) large blood vessels (aorta, vena cava) and the intestines, there is a wide exposure of the intervertebral disc without retraction of the spinal nerves and neurologic structures (and therefore, a decreased risk of neurologic injury).
How Is An ALIF Performed?
For an ALIF procedure, the patient is positioned on his or her back and sedated under general anesthesia. The surgeon then
- Makes an incision in the abdomen and retracts the abdominal muscles, organs and vascular structures – including such major blood vessels as the aorta and vena cava – for a clear view of the front of the spine and access to the vertebrae.
- Removes all or part of the degenerated disc(s) from the affected disc space, and inserts bone graft or bone graft substitute into the disc space between the vertebral bodies, to support the disc space and promote bone healing
- Returns the abdominal organs, blood vessels and muscles to their normal place, and closes the incision
Surgeons typically perform an ALIF as a traditional, open procedure as described above; however, another option is to access the spine using minimally invasive (endoscopic) technologies that allow surgeons to reach the affected vertebrae through small incisions and intramuscular tunnels created to accommodate special guidance, illumination and surgical tools.
Why Do I Need This Procedure?
There are a number of reasons your surgeon may recommend spinal fusion. This procedure is frequently used to treat
- One or more fractured (broken) vertebrae
- Spondylolisthesis (slippage of one vertebral bone over another)
- Abnormal curvatures of the spine, such as scoliosis or kyphosis
- Protruding or degenerated discs (the cartilaginous “cushions” between vertebrae)
- Instability of the spine (abnormal or excessive motion between two or more vertebrae)
Patients with low back and/or leg pain due to degenerative disc disease, spondylolysis/spondylolisthesis, scoliosis, or other spinal instability that have not responded to non-surgical treatment measures (rest, physical therapy or medications) may be suitable candidates for an ALIF.
Patients without an excessive amount of spinal instability or slippage, and who have little to no spinal stenosis or nerve compression in the back of the spine, are generally the best candidates for an ALIF alone. However, ALIF as a stand-alone technique is usually not recommended for people whose bones have become very soft due to osteoporosis, or in patients with instability or arthritis.
Your surgeon will take a number of factors into consideration before recommending an ALIF, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. Please discuss this treatment option thoroughly with your spinal care provider.
How Long Will It Take Me To Recover?
The recovery period for a spinal fusion procedure such as an ALIF will vary, depending on the procedure and your body’s ability to heal and firmly fuse the vertebrae together. One advantage of an ALIF is that the back muscles and nerves are undisturbed.
Most patients are usually able to go home 3-4 days after surgery. Patients will typically stay longer, approximately 4-7 days, if a posterior spinal surgery is also performed. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury. Patients can gradually begin to bend, twist, and lift after 4-6 weeks as the pain subsides and the back muscles get stronger.
Work closely with your spinal surgeon to determine the appropriate recovery protocol for you, and follow his or her instructions to optimize the healing process.