ALIF

What is an ALIF Procedure?

Anterior lumbar interbody fusion (TLIF) refers to a surgical option that involves approaching the spine from the front of the body to remove the disc in between two adjacent lumbar vertebrae ¹. Surgeons perform this operation to treat disc problems in the lower back. This operation requires the assistance of a vascular surgeon to move the major blood vessels out of the way. By removing the disc from the adjacent vertebrae, this procedure relieves the pressure on the nerve. This procedure helps to join the vertebrae on either side of the remaining disc space by using a screw and a cage in the lower back or bone graft. This graft material acts as a binding medium and helps to maintain normal disc height ².

ALIF makes a permanent union of two or more spinal bones and performed for several reasons. Basic indications of ALIF include painful disc degeneration, spondylolisthesis, instability of the spine, spinal deformity or imbalance, spinal stenosis, and scoliosis or flat back syndrome. ALIF procedure performs in a very well tolerated way and associated with less pain and faster recovery than spinal fusion surgery. ALIF allows a larger cage placement when compared with a typical spinal fusion ¹.

This procedure provides more stability and increases the chance of solid fusing. Anterior fusion allows the surgeon to avoid working around the spinal nerves. ALIF allows better correction of spinal deformity and helps to improve the outcome of long-term pain and thus, improves the quality of life by reducing the chance of developing problems in the spine. Depending on the condition, a surgeon may perform a one-level or multi-level fusion in the lower back. A one-level fusion involves the joining of two bones, while two-level fusion helps to join three bones in the spine ³.

Who is an ideal candidate for an ALIF procedure?

Surgeons will not recommend doing this operation in patients having those problems ¹:

• Those who have problems that would prevent bone fusion
• Those who undergo prior abdominal surgery
• Those who have atherosclerosis of the aorta or iliac vessels
• Those who have obesity and severe osteoporosis

An ideal candidate should possess some conditions like spinal instability, spinal stenosis, scoliosis, or pain caused by several reasons. A patient already undergone several nonsurgical conservative treatments may try this option. This fusion results in changes in the normal spinal movement and reduces the pain level. The surgeon will explain the options to the patient before performing this operation. The patient will discuss the benefit and risk of this operation prior to the surgery. Moreover, surgeons will help patients in deciding the best approach for the ALIF procedure.

How do Neurosurgeons perform an ALIF procedure?

ALIF procedure requires a professional medical team led by an expert neurosurgeon with an orthopedic surgeon, a vascular surgeon, an anesthesiologist, and nurses to perform successfully. The entire operation can take as long as 6 to 7 hours to complete. Many spine surgeons possess specialized training and degree in this specific area. The basic steps include ⁴:

• Patients will lie on their stomach with pillows supporting each side of the body
• Anesthesiologists will administer general anesthesia to the patient to fall asleep and nurses will prepare the incision site.
• Neurosurgeons will make a small incision in the abdomen and retracts the abdominal muscles, organs, and vascular structures for a clear view of the front of the spine and access to the vertebrae
• Surgeon will remove the bone spurs and disc nucleus from the affected disc space and inserts a bone graft into the disc space between the vertebral bodies
• This helps to support the disc space and promote bone healing
• Finally, surgeons will put the abdominal organs, blood vessels, and muscles to their normal place and suture the skin together.

Research shows that the ALIF procedure improves the patient’s condition by 65% to 80% ⁵. Approximately 85% of the patient shows their satisfaction after ALIF fusion surgery. During any operation, complications may arise. Potential complications of ALIF include infection, nerve damage, blood clots, blood loss, and bowel and bladder problems. A follow-up monitoring for 24 to 48 hours requires the patient after surgery. The patient will take 6 to 12 weeks for a full recovery ¹. In the case of any complications, consult with surgeon immediately.

Reference

1. Mobbs, R. J., Phan, K., Malham, G., Seex, K. & Rao, P. J. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J. spine Surg. (Hong Kong) 1, 2–18 (2015).
2. Rao, P. J., Loganathan, A., Yeung, V. & Mobbs, R. J. Outcomes of anterior lumbar Interbody fusion surgery based on indication: A prospective study. Neurosurgery 76, 7–23 (2015).
3. Luca Schmid, S., Anton Krappel, F. & Marmentini, S. Fusion of the L5-S1 Segment in Degenerative Lumbar Spine Disease Using the Extreme Lateral Interbody Fusion Technique: A Case Report Study. Arch. Clin. Med. Case Reports 03, 651–659 (2019).
4. Mobbs, R. J., Lennox, A., Ho, Y.-T., Phan, K. & Choy, W. J. L5/S1 anterior lumbar interbody fusion technique. J. Spine Surg. 3, 429–432 (2017).
5. Kapustka, B. et al. Anterior lumbar interbody fusion (ALIF): biometrical results and own experiences. Neurosurg. Rev. 43, 687–693 (2020).