An anterior lumbar interbody fusion (ALIF) is a minimally invasive spine surgery that removes a painful spinal disc in the back, replacing it with a bone graft creating a fusion between two vertebrae.
The ALIF can sometimes be performed in conjunction with a posterior laminectomy and secondary fusion with screws and rods. When the two procedures are performed, it is referred to as a 360 fusion with a fusion in the disc space and a fusion in the facet joints with screws and rods.
As technology advances, so does the ALIF technique. ALIF now has a 95% success rate, causing this surgery to become a standard and effective treatment option.
An ALIF is usually preferred in situations where access to the front of the spine is closed off from the back. This can include conditions that cause narrowing in the spinal canal or vertebrae misalignment, such as:
ALIF can also treat a failed posterior lumbar interbody fusion (PLIF) — a similar surgery with an approach from behind.
As with most surgeries, the patient must be cleared before undergoing the procedure. The significant indicator of the need for ALIF is if all other non-surgical approaches have been exhausted. These treatments can include physical therapy, medications or steroid injections.
An ALIF candidate must also show signs of instability, weakness and pain that are not responsive to conservative treatments.
You may be a candidate if you have:
degenerative disc disease
Before surgery, a doctor will request preoperative testing to ensure proper qualifications are met. This testing will likely be in the form of a medical physical, involving blood work and other various tests to ensure your body can undergo anesthesia and surgery.
Once cleared, the patient will need to ease off habits such as smoking and drinking, which could interfere with proper healing following surgery. It is also recommended to refrain from taking any NSAIDs like Aspirin or Advil for pain, as these can thin the blood and cause potential complications.
The patient will be asked not to eat or drink anything after midnight the night before. Be sure to communicate with a surgeon about any allergies, medications or current health conditions that could affect the surgical outcomes.
Once the patient is taken to the operating room, the medical staff will start an IV to provide them with fluids and medications to make them sleepy. ALIF is done under general anesthesia.
Once the anesthesia has been given, the patient is placed on their back on the operating table. The surgical technique is done through an incision in the abdomen muscles, retracting (moving) the intestines, and large blood vessels to expose the anterior — or front — of the spine and verterbal disc. The advantage of this approach is it avoids spinal nerve retraction and therefore decreases risk of neurologic injury.
In some cases, the surgeon may do what they call a 360 fusion. After the disc is removed and replaced with a bone graft, the incision is closed. The operating team then will flip the patient over onto their stomach and the surgeon will place pedicle screws and rods through two small incisions in the back for a secondary fusion.
Patients tend to stay in the hospital for one or two nights as medical professionals monitor the patient and ensure no complications are present. The patient will need to be able to walk and perform daily living activities on their own — going to the bathroom, eating, brushing their teeth and dressing — before being discharged from the hospital.
The primary concern with ALIF is that the added bone graft will not successfully fuse with the rest of the vertebrae, therefore not providing the wanted pain relief.
This outcome can be enhanced by carefully following your surgeon’s recommendations. Wearing your back brace, not smoking, and eating healthy can also ensure the fusion takes place.
Other potential complications include:
All surgical procedures come with a risk of extreme blood loss, but this is uncommon at the hands of experienced professionals.
A recovery and exercise plan may be given to the patient to encourage movement and strengthening during a six- to 12-week period after surgery.
Keep in mind that the vertebrae are not completely fused to the bone graft in surgery. Instead, complete fusion can take up to 12 months. Schedule several follow-up appointments to make sure proper healing occurs.
Choosing ALIF comes with a series of advantages for the patient. Benefit from:
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