Anterior Interbody Lumbar Fusion (ALIF)

At one time or another 8 in 10 people have some level of back pain in their life. Most of these clear up on their own. But when the pain is chronic, surgery may be necessary. An anterior lumbar interbody fusion (ALIF) can be used for a variety of painful spinal conditions, including degenerative disc disease and spondylolisthesis.

The procedure allows surgeons to fuse the lumbar spine bones together, removing and replacing the intervertebral disc with bone or a metal spacer. A newer form of treatment uses an intervertebral fusion cage that uses a hollow cylinder made of metal, usually titanium. Bone graft can then be placed inside the cylinder, promoting fusion between the two vertebrae. Eventually, new bone grows around the cage, turning the two vertebrae into a single solid one.

The surgery can be performed laproscopically or through an open incision through the abdomen. If minimally invasive techniques are employed, instruments are inserted through small incisions and guided to the location where the damage to the vertebrae has occurred. Because every patient is different, minimally invasive options may be limited. In that case, an open incision is used instead to create better access to the vertebrae that need to be fused.

What is involved in ALIF procedure?

After positioning you on your back, the surgical team will administer general anesthesia. A single incision or several smaller incisions (in the case of minimally invasive ALIF) will be made in the abdomen. Retractors are used to move the abdominal muscles and peritoneal sac out of the way as well as the larger blood vessels. 

Once your surgeon has confirmed the correct location of the vertebrae in question, the disc will be removed using specialized instruments. After determining the correct thickness, the spacer is installed. The entire procedure takes between two and three hours. Fluoroscopic x-rays are taken to confirm that the spacer is in the correct position.

What should I expect after the surgery?

Most patients can go home three to four days after surgery in the case of an open procedure. If  MIS anterior interior lumbar fusion is conducted instead you may be able to go home after two days.

Your doctor will advise you to take it easy for a few weeks and you will be fitted for a custom brace. You may not be able to drive for a couple weeks after surgery. You will want to check with your doctor before you return to any level of normal activity.

Since your intestines will have been manipulated during surgery, they may not work properly for a couple days. Your doctor may recommend smaller meals initially until your intestines return to their normal position.

Outpatient physical therapy may be ordered for a period of up to 12 weeks. This will help you regain your strength and function so you can lead a normal, active life.

As with any surgery there can be complications, including bleeding, nerve disruption, infections, blood clots and implant migration, but most of these can easily be managed during recovery. If you experience any unusual symptoms, you’ll want to discuss them with your doctor during your post-operative visits and exams.