An anterior lumbar interbody fusion surgery is done from the anterior (front), and like the other types of fusion surgery, it is designed to stop the motion at the painful segment of the spine .
An ALIF is performed in the lower or lumbar region of the spine. The two segments that are most likely to require a fusion surgery are pictured below: the L4 through L5 region and the L5 through S1 region.
The most common reason an ALIF is performed is to treat symptomatic lumbar degenerative disc disease.
ALIF has indications other than lumbar degenerative disc disease. Additionally, for added stability, your surgeon may combine this procedure with an approach from the posterior as well.
To get started, your surgeon will make a 3- to 5-inch long incision on the left side of your abdomen.
Next, your surgeon will move your abdominal muscles, depicted here in purple, to the side. No cuts will have to be made to the muscles because they run laterally and are retracted easily.
The contents of your abdomen are contained by a large sack called the peritoneum. Your surgeon will retract the peritoneum to the side, allowing him or her access to your spine without actually entering into your abdomen.
A vascular surgeon will usually be a part of the surgery to assist in moving the large blood vessels, the aorta and vena cava, which lay on top of the spine, to the side.
Your surgeon will then proceed to remove the disc material in the affected disc.
Next, your surgeon will place a type of implant called a cage into the disc space to help restore the normal spacing between the vertebrae. The cage will also help alleviate pressure on the nerve roots.
Your surgeon will now place bone graft in the cage and in front of the cage. They may also insert screws through the cage for additional stability.
If you are using your own bone graft, your surgeon will take bone morsels from your iliac crest, or hip bone, during an additional surgical procedure. You may also have the option to use a synthetic bone graft.
This image shows the results as the bone graft heals together in the months after the surgery. The fusion has created one long bone between the vertebrae and immobilized that segment of the spine.
Fusion rates for ALIF should be between 90-95%. In an ALIF, the bone graft is placed in the front of the spine, in compression, which increases the strength of the fusion.