What are the indications for an ALIF surgery?
Anterior Lumbar Interbody Fusion (ALIF) is an operation whereby the disc is removed and a specialized spacer packed with bone fusion material is placed in the disc space, accompanied by screws fixated into the vertebrae above and below. This type of fusion is unique as the surgery is done from the front, or anterior with the incision made in the vicinity of the umbilicus. An ALIF is most commonly done to treat low back pain from a lumbar degenerative disc. It is advantageous because the anterior approach does not require dissection of the back muscles or removal of the posterior spine elements such as the lamina or facet joints in order to obtain access to the disc thereby not causing any disruption of the low back anatomy. Also, there is direct exposure of the disc allowing for a larger interbody cage to be placed and therefore greater surface area for the bony fusion. The ALIF approach does not allow for good access to the nerves and therefore is not the optimal procedure to relieve pressure on a pinched nerve. If there is significant leg pain from a pinched nerve, the posterior approach is favored over the ALIF procedure.
How is an ALIF performed?
The surgery is performed under general anesthesia. The procedure starts with a 3-5 inch long incision over the abdominal area. The abdominal muscles are dissected and retracted to the side. The abdominal contents lay inside a large sac (the peritoneum) that is then retracted to the side allowing access to the front of the spine without actually entering the abdomen. The large blood vessels that supply blood flow to the legs lay on top of the spine and are usually dissected and gently retracted to allow access to the desired disc. A vascular surgeon will assist in obtaining access to the spine. The disc is then removed and the bony edges of the vertebrae are scraped and prepared for the placement of an interbody cage (spacer) with bony fusion material inside the cage. Once the cage is in good location, at the desired disc space, anchoring titanium screws are placed into the vertebrae above and below the disc space to anchor the cage. The abdominal layers are closed and absorbable sutures are placed under the skin. The surgery typically takes 2-4 hours depending on the complexity of the anatomy and the number of disc levels fused. Usually one, sometimes two discs, are fused.
What is the recovery for an ALIF surgery?
The hospital stay is generally 3-4 days. There is usually abdominal pain from the approach and pain in the back area. The surgical pain usually significantly improves within 6-8 weeks. It is anticipated that the pain in the low back should feel improved after 3-6 months. Activity recommended for the first 2 weeks after surgery is short walks and mainly rest. Physical therapy guidance is recommended from 2-3 weeks after surgery for 6-8 weeks. Return to work can vary depending on the extent of surgery, rate of recovery, and physical demands of the job. For a nonphysical job, reasonable timeline to return to work is 3-4 weeks to 3 months whereas more labor intensive work may require to be out of work for up to 3-6 months.