Understanding the Basics of ALIF

Spine surgery isn’t one-size-fits-all. When my patients come in to discuss surgery, it’s important to develop an individualized approach and tailor their treatment to what’s best for their particular case.

Spinal fusion is a good example of this. There are a few different ways of performing a spinal fusion, each with its own benefits and risks. When deciding which method to use, everything from a patient’s anatomy to ultimate treatment goals should be considered.

Here, we’ll discuss one type of fusion surgery called anterior lumbar interbody fusion, or ALIF.  For this surgery, a surgeon accesses your spine from the anterior, or front, of your body, versus entering through your back or side.

Who is a good candidate for ALIF?

As you get older, your intervertebral discs, which act as shock absorbers in-between the bones of your spine, start to wear down. In some cases, this can become painful to the point that it interferes with your daily life. If nonsurgical treatments aren’t helpful in correcting this, you may be a candidate for ALIF. This surgery can help people who have:

• Instability in their spine from disc degeneration or trauma

• Collapse in the height of the disc space (the space between the bones)

• Slippage of the bones in the spine, called spondylolisthesis

What happens during ALIF surgery?

Often, a spine surgeon will work together with a vascular surgeon, who specializes in working with blood vessels, during an ALIF procedure. You’ll be given a general anesthetic, and a small incision will be made in your abdomen. The organs and big blood vessels in the area are carefully moved to the side to expose your spine. The damaged disc material is then removed, and an implant called a cage is inserted into the space. Your internal structures will be moved back to their proper place, and the incision will be closed with sutures.

As your body heals post-surgery, the implanted cage fuses with the bone above and below it, essentially making it one solid piece of bone. This often helps improve stability and diminish pain in the area.

There are a number of advantages to performing the spinal fusion from the anterior side:

• This method gives us a large “footprint,” or area to work with. We can access the whole disc and implant a large cage to provide better support.

• Having a larger surface area to work with also allows for a better fusion of the bones.

• We can better elevate the disc space. This relieves painful pressure on surrounding nerves.

What are the risks associated with ALIF?

All surgeries have risks. With ALIF, we are working in close proximity to some major blood vessels, including the aorta, and complications can result if one of those vessels is injured during surgery. This is why we have a vascular surgeon on hand during the procedure to help minimize this risk.

Other potential risks include the development of blood clots, damage to the ureter (the structure that transports urine from the kidneys to the bladder), and infection.

I find that many of my patients are worried about permanent nerve damage or paralysis occurring as the result of spine surgery. However, this is actually one of the least common complications that we encounter. In my own experience, less than 1 percent of surgeries result in these issues.

What can be expected with recovery from ALIF?

You’ll be up and walking immediately after surgery, but should expect to spend at least one night in the hospital. More complex cases might require a longer stay. Though you should be feeling well enough to take basic care of yourself, we recommend that you have someone to assist you at home once you are discharged.

The goal of surgery is to improve your overall function and quality of life, but be aware that it is a gradual process. You should continue to feel better with each passing week. You’ll start physical therapy about 6 weeks after surgery. We’ll keep monitoring your healing and check X-rays of your spine every 2-3 months.  

Once you’ve made the decision to proceed with ALIF, as I like to remind my patients, now is not the time to do anything extreme. Whether it’s starting a fad diet or trying some new supplements, sometimes things you think seem good for you can have negative effects on your health. After surgery, we’ll help get you on a safe and healthy road to recovery.