Anterior Lumbar Interbody Fusion (ALIF)

What is ALIF surgery?

ALIF (anterior lumbar interbody fusion) is surgery to treat degenerative disk disease and other conditions that happen when damaged or worn-out intervertebral disks put pressure on your spinal nerves. Intervertebral disks are the round cushions in your spine that separate and cushion your vertebrae. In ALIF, surgeons replace your damaged disks with bone grafts, reducing pressure on your spinal nerves. These grafts eventually create new bone that fuses or joins vertebrae together.

Why is it called ALIF surgery?

Anterior lumbar interbody fusion is a type of spinal fusion. It gets its name from the way healthcare providers perform the operation: Surgeons access your lower back (lumbar) from the front (anterior) of your body by making an incision in your abdomen (belly) so they can insert a bone or titanium graft between your vertebrae (interbody) that will fuse or join your vertebrae (fusion).

Why would I need ALIF surgery?

Surgeons use ALIF to treat conditions including:

• Lumbar radiculopathy.
• Spondylolisthesis.
• Spinal conditions like scoliosis.

Your surgeon may recommend ALIF if you’ve already had multiple spinal operations.

How common is ALIF?

It’s a common surgical treatment for degenerative disk diseases and other conditions that cause severe lower back pain because damaged disks put pressure on spinal nerves. Typically, ALIF and other lumbar surgery happen when pain management, physical therapy or other treatments haven’t eased back issues.

Is ALIF major surgery?

While ALIF is minimally invasive spine surgery, it’s still major surgery. ALIF is done under general anesthesia and involves an access surgeon making an incision in your abdomen (belly) so a spine surgeon can access your lower back to remove the worn-out disk and replace it with a graft.

What happens before ALIF?

A lot goes on before your surgery:

Several weeks before ALIF surgery

The first step is confirming that ALIF is the right treatment to ease your back pain. Your surgical team will ask about your medical history, including any abdominal surgeries that may have left scar tissue in your abdomen. Your team may:

• Ask if you take any prescription or over-the-counter medications or supplements (including herbal ones).
• Do blood tests and other tests to check your overall health.
• Encourage you to stop smoking or using tobacco if you use tobacco in any form. Studies show nicotine use makes it hard for your new bone grafts to grow and your surgical wound to heal. It also increases your risk of infection. Your team will recommend smoking cessation programs to help you quit.
• Discuss options for the bone graft material that will replace your damaged disk.

Seven days before ALIF surgery

You should:

• Limit the number of beverages containing alcohol that you drink.
• Stop taking NSAID (nonsteroidal anti-inflammatory drugs) and anticoagulant (blood-thinning) drugs.
• Make plans to be in the hospital for several days after surgery.
• Plan to have someone available to stay with you for the first 24 to 48 hours after you go home.

The day of ALIF surgery

You should:

• Stop eating or drinking anything after midnight. If you must take certain medications, you can take a sip of water.
• Take a shower, using antibacterial soap.
• Wear loose-fitting clothes that won’t rub against your incision.
• Remember to bring medications for other conditions with you to the hospital.

At the hospital, you’ll meet with your anesthesiologist. They’ll explain the type of anesthesia you’ll receive and what to expect as you recover from anesthesia.

A healthcare provider will take you to the operating room where you’ll lie face up on an operating table. You’ll receive anesthesia that will make you unconscious. Your team will clean the skin on your belly.

What happens during ALIF?

ALIF surgery involves an access surgeon and a spine surgeon. Your access surgeon will:

1. Make a small incision in your lower abdomen, below your belly button and in the area of your damaged disk(s). The incision may be 2 to 3 inches long.
2. Spread your abdominal muscles so they can reach your peritoneal sac that holds your intestines. Your access surgeon will move your peritoneal sac and blood vessels so your spine surgeon can reach your vertebrae.

Next, your spine surgeon will:

1. Remove the damaged disk and size the space to be filled with the graft.
2. If needed, they’ll secure the graft with devices to hold the graft in place.
3. Once your spine surgeon is done, your access surgeon will remove the surgical tools holding your intestines and blood vessels.
4. They’ll reconnect your abdominal muscles with internal stitches and close the incision.

Depending on your situation, your spine surgeon may want to do additional surgery to add more stabilizing devices. Your spine surgeon will explain why they recommend this and what you can expect.

How long does ALIF take?

A typical surgery takes about one to two hours. Your surgery could take more time if your surgical team needs to replace several damaged disks or if you’ve had previous abdominal surgery.

What happens after ALIF?

Your team will move you to a recovery area, where you’ll rest while you recover from anesthesia. Your recovery room team will regularly check your pulse, breathing and other vital signs, and give you medication for pain.

You’ll move to another room in the hospital to continue recovering from your surgery. Your surgical team will check for complications like infections. You may need to spend three or four days in the hospital. While you’re there, your team will help you take small steps toward recovery, like standing and walking on the first day after surgery.

What are the advantages of ALIF?

There are several advantages:

• ALIF may be an option if you’ve already had posterior lumbar interbody fusion (PLIF), which involves accessing your spine by making incisions in your lower back.
• It’s less invasive than PLIF, so you have less muscle injury, and you may recover more quickly.

What are ALIF side effects and complications?

Like most surgeries, ALIF complications may include risk of infection and excessive blood loss. Other potential complications include:

• Nerve damage.
• Damage to your bowels, bladder or blood vessels.
• An incisional hernia, when a muscle in your belly seems to stick out from the incision in your belly.

How long does it take to recover from ALIF surgery?

ALIF surgery recovery is a marathon, not a sprint. It can take several months before you can do things like lift heavy objects, bend at the waist or twist your upper body. If you had several damaged disks, you may never be able to lift heavy weights, do work that requires lifting heavy weights or take part in impact sports.

How long does it take for a bone graft to fill in the spaces between my vertebrae?

Bone growth is steady but slow. It could take a full year before your bone graft completely fills in the space and fuses with your vertebrae.

How can I take care of myself after ALIF?

Three words: Take it easy. It may be several weeks before you’re able to do things like bend, twist, lift objects or drive without pain.

How successful are ALIF surgeries?

Research shows ALIF successfully treats symptoms from conditions that damage vertebral disks. One study showed successful bone fusion in 99% of ALIF surgeries.

When should I see my healthcare provider?

You should contact your provider if:

• You have fever, chills or your surgical site is red and tender to the touch. These symptoms may mean you have an infection.
• You have more pain than you expected and your pain medication doesn’t ease your pain.