Anterior lumbar interbody fusion (ALIF) is one of the most frequently used spinal fusion techniques and is performed through the front of the body (anterior approach). Interbody fusion refers to the removal of an intervertebral disc, which is replaced with a spacer during the fusion process. A major advantage of anterior entry is that a larger implant can be incorporated into the procedure.
ALIF is performed to treat deformity of the spine, nerve compression, and associated pain. Such compression of spinal nerves may occur as a result of progressive disc degeneration, slippage of the vertebrae (spondylolisthesis), abnormal curvature of the spine (scoliosis, kyphosis, or loss of lordosis), or other causes of progressive spinal instability. The ALIF procedure is typically used to fuse either the lowest level of the spine (L5/S1), the second-lowest level of the spine (L4/5), or both.
Patients with persistent low back pain, which often radiates down the leg, may be candidates for ALIF if more conservative treatments, such as rest, non-steroidal anti-inflammatories (NSAIDs), physical therapy and corticosteroid injections, have not been effective in relieving their symptoms.
Patients undergo the ALIF procedure under general anesthesia and lying face-up on an operating table. The surgeon makes a small incision on the side of the abdomen near the affected area through which the injured disc and other debris are removed.
A cage (or spacer) is then inserted in the disc space. The cage is typically made of either titanium or plastic and packed with bone graft. After inserting the cage, the surgeon will place either a metal plate or screws and rods in the vertebrae to maintain stability of the spine around the cage as the vertebrae grow together and fuse.
After undergoing an ALIF procedure, patients typically remain in the hospital overnight. Sometimes, a longer length of stay is required if the ALIF is performed as part of a multi-stage procedure. A physical therapy regimen is started soon after to assist the patient in regaining strength and mobility. Certain activities may be restricted, including lifting, twisting the midsection, and bending at the waist. Many patients can return to work within a few weeks after the procedure if their employment does not require strenuous exertion. However, heavy lifting and manual labor are prohibited for 3-6 months after the procedure, depending on the extent of the surgery.