Anterior/Posterior Lumbar Fusion Surgery

Sometimes, both an anterior lumbar interbody fusion and a posterolateral gutter fusion surgery will be performed and both the front and back of the spine will be fused.

This anterior/posterior lumbar fusion procedure is usually done for patients with a high degree of spinal instability (e.g. fractures), or in revision surgery (if the initial fusion did not set up), although some spine surgeons do prefer the anterior/posterior fusion surgery as a primary spinal fusion technique.

Fusing both the front and back provides a high degree of stability for the spine and a large surface area for the bone fusion to occur. Also, approaching both sides of the spine often allows for a more aggressive reduction for patients who have deformity in the lower back (e.g. isthmic spondylolisthesis).

Most times, the anterior (from the front) approach is performed first. By removing the disc material and cutting the anterior longitudinal ligament (which lays on the front of the disc space), the spinal segment is "released" and allows for a more complete reduction. After the anterior and the posterior spinal implants are inserted, this segment is much more stable than even a normal spine segment.

Some spine surgeons feel that if stabilization is achieved both through an anterior and a posterior approach, patients can be mobilized earlier in the postoperative period. Studies have shown that fusing both sides of the spine in the lower back does lead to a very high fusion rate (greater than 95% of these cases will achieve a solid fusion).

A drawback of the procedure is that both an anterior incision in the abdomen and a posterior incision in the low back need to be done. Some spine surgeons prefer to achieve anterior and posterior stability through a PLIF procedure, although there are drawbacks to approaching the disc space through a posterior approach (please see the PLIF section). Spine surgeons with a strong comfort level with doing ALIF surgery generally prefer an anterior/posterior approach.

This technique does provide for very high rates of spinal fusion, but the spine fusion surgery is quite extensive and carries the risks inherent in both the ALIF and the posterolateral gutter fusion procedures.

• Article written By:
• Peter F. Ullrich, Jr., MD

January 20, 2004

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