Low back pain is a common occurrence, and while the majority of cases will resolve with time, some people may require surgery to relieve their pain. A surgical technique called Anterior Lumbar Interbody Fusion, or ALIF, is one method that may be used to treat lower back pain resulting from certain spine conditions. Below, we’ll explain what the procedure entails and help you identify if you might be a potential candidate.
What Causes of Low Back Pain Can Be Treated with ALIF?
Your lumbar spine is in the area of your lower back. It is made up of five bones called vertebrae, and in-between each bone is a disc that helps cushion the joint. Since your lower spine is forced to bear a lot of weight, these discs can become damaged over time, resulting pain in your back and lower extremities. ALIF can be helpful in treating this type of degenerative disc disease.
ALIF is also used to treat other painful conditions, including:
- Spondylolisthesis, a condition where one of your vertebrae slips over the vertebra below it
- Instability in the spine due to a trauma
- Collapse in the height of the disc space (the space between the bones)
What Happens during an ALIF Procedure?
You’ll be placed under anesthesia, and your surgeon will make a small incision on your lower abdomen. Your abdominal muscles, organs, and large blood vessels will be carefully moved to the side, so the surgeon can access your spine. The damaged lumbar disc is removed and a special implant called a cage is placed in the open space. This helps restore the proper spacing between vertebrae and relieves pressure on surrounding nerve roots. Everything in your abdomen will then be returned to its original place, and the incision will be closed. The surgery itself takes a few hours.
In the months following the procedure, the implanted cage fuses with the bone above and below it, essentially making it one solid piece of bone. The goal is to provide stability to the spine and eliminate pain.
What Are the Advantages of ALIF?
There are a few reasons that ALIF may be a desirable treatment option. Using an anterior approach (through the abdomen) versus a posterior approach (through the back) allows the surgeon to:
- Leave the back muscles and nerves undisturbed.
- Access the whole disc and implant a large cage to provide better support, because they have a bigger area to work with.
- Having a larger surface area to work with also allows for a better fusion of the bones.
- Better elevate the disc space. This relieves painful pressure on surrounding nerves.
- Use a larger implant, which leads to better stability in that area of the spine.
How Do I Know If I’m a Candidate for ALIF?
Your doctor will review your case on an individual basis. Your age, health, previous surgical history, and coexisting medical conditions will be evaluated. If you have certain conditions, such as active infection, osteoporosis, or allergy to the implant materials, ALIF may not be the right choice for you.
Also, before resorting to surgery, your doctor will want to make sure you have tried other, more conservative treatment measures for an extended time without success. This includes things like rest, anti-inflammatory medications, and physical therapy.
ALIF is generally most successful in cases where only one level of vertebrae is involved and there is not a large amount of spinal instability. In more complex situations, ALIF may need to be performed in conjunction with another procedure from the posterior approach.
What Are the Risks Associated with ALIF?
All surgeries have risks. With ALIF, the surgeons 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 there is a vascular surgeon on hand during the procedure to help minimize this risk.
Though your surgeon will do everything possible to minimize the chance of any potential complications, risks may include:
- Nerve damage
- Reaction to anesthesia
- Retrograde ejaculation in males
- Failure of the bone graft to fuse the adjacent vertebrae
The best way to determine if ALIF is right for you is by scheduling a consultation with a spine surgeon. This face-to-face meeting will allow the surgeon to evaluate your case, address your concerns, and begin to develop a plan to bring you the pain relief you deserve.
About the author
Richard Kim, M.D. Born and raised in Southern California, Dr. Richard Kim earned his undergraduate degree in biochemistry from University of California, Riverside. This followed with a Master of Science in biochemistry and neurophysiology. He then earned his medical degree from St. Louis University School of Medicine in Missouri, graduating Magna Cum Laude. Read more articles by Richard Kim, M.D..