Anterior lumbar interbody fusion, often abbreviated ALIF, is a type of spine surgery performed to treat low back disorders including degenerative disc disease (DDD) and spondylolisthesis. DDD and spondylolisthesis are examples of spinal problems that may compress spinal nerves and cause instability. Compression or pinching of nerve structures may cause low back, buttock and leg pain. Other neurologic symptoms may include numbness, tingling and weakness in one or both legs. The goal of an ALIF procedure is to decompress the nerves, stabilize the lumbar spine, relieve symptoms, and enable the patient to return to regular activities of daily living.
Anterior = front
The surgical incision is made in the abdomen (eg, stomach area) usually on the left or right side.
Lumbar = low back
The lumbar spine is one region of the spine. There are five vertebral bodies in the low back; numbered L1 (top) through L5 (bottom). The disc levels are also abbreviated. For example, L3-L4 refers to the intervertebral disc space between the third and fourth lumbar vertebral bodies (bones).
Interbody = between two vertebral bodies
The interbody space is the disc space.
Fusion = to join or combine
Bone graft is inserted into the empty space between the upper and lower vertebral bodies. Instrumentation (eg, cages, plate, screws) is implanted to immobilize (stabilize) the low back. The body’s natural healing processes cause new bone to grow into and around the instrumentation resulting in a spinal fusion.
Not every patient with lumbar degenerative disc disease or spondylolisthesis requires spine surgery. Dr. Stieber may recommend ALIF for the following reasons: non-operative treatment fails to relieve symptoms, progressive worsening of neurologic symptoms or pain, spinal instability, and/or neurological problems. Numbness, loss of function, and weakness are examples of neurologic dysfunction.
About the ALIF Procedure
Video: Anterior Lumbar Interbody Fusion
Click below to view a video from our library about this procedure.
Anterior interbody fusion is performed under general anesthesia. The low back area is cleansed and prepared for surgery. The size of the incision depends on the number of spinal levels to be treated and whether the surgery is open (3- to 5-inch incision) or minimally invasive (one or a few tiny incisions).
Soft tissues (eg, muscles) are gently pulled aside to expose the spine and disc. Dr. Stieber uses fluoroscopy, a type of real time x-ray during surgery. A thin needle is inserted into the disc, which can be viewed on fluoroscopy. Specialized surgical instruments are used to remove the all or part of the disc. The empty disc space is filled with bone graft and an interbody spacer(s) is implanted (such as 2 cages).
Pre- and post-operative images of benefit:
Sometimes, an ALIF procedure is combined with posterior instrumentation. Posterior fusion means the instrumentation (screws and rods) are implanted in the back of the spine.
Types of Bone Graft:
- Autograft is the patient’s own bone; usually taken from the hip.
- Allograft is donor bone from a bone bank.
- Bone graft substitute; there are different types, some of which are synthetic (man-made) and available in different shapes.
After surgery, the patient is moved into the recovery area. In recovery, nurses and other members of the medical team closely monitor the patient’s vital signs – pulse, respiration, blood pressure, and pain. Some post-operative pain should be expected and patients receive pain medication either through their IV (intravenous line) or by mouth. Dr. Stieber discusses the likelihood of hospitalization with patients before their surgery date.
After Care at Home
Dr. Stieber provides ALIF patients with information about what to expect and self-care after hospital discharge. This information includes instructions to control pain, medications, diet and managing constipation, bathing and incision care, activity restrictions, and the surgical follow-up appointments. As always, Dr. Stieber and his staff welcome questions and ensure that all patient concerns are thoroughly addressed.