What is ALIF Spine Surgery?
Anterior lumbar interbody fusion surgery (ALIF) is a type of spinal fusion used to treat pain and discomfort in the lower back or legs from degenerative disc disease or spondylolisthesis.
This spinal fusion surgery is performed by removing the intervertebral disc from an anterior approach to access the front of the spine and placing a bone graft or synthetic spacer into the disc space. It is usually performed through an open abdominal incision but can be performed in a minimally invasive fashion as well.
The goal of the surgery is to remove pressure on nerves in the lumbar spine and create an environment where, over the course of several months, the body forms a bony bridge across two spine bones called vertebra, thereby “fusing” a joint that has become defective from aging or some other kind of destructive process. Another medical term for fusion is “arthrodesis.”
ALIF Surgery is performed by entering from the front of the body (anterior) via an incision created in the abdomen.
A vascular surgeon usually performs the approach because the front of the spine and disc space are covered with large blood vessels called the internal iliac veins, the vena cava, and the aorta. These are the large blood vessels that carry blood from the heart to the legs.
The main job of the vascular surgeon is to move these blood vessels to the side so that the spine surgeon can access the spine to perform the spinal fusion surgery. The intervertebral disc is removed and replaced with some kind of spacer, either a bone graft or a wedge-shaped implant made out of carbon fiber or titanium.
The job of the spacer is to stabilize the joint so that it doesn’t move and to separate or “distract” the vertebra in an open position that gives the nerves more room.
Instrumentation is then placed to further stabilize the area, usually a plate with screws that are placed in the front of the spine. Sometimes pedicle screws are placed as well through separate incisions made in the back.
Recovery After ALIF Surgery
Those that undergo ALIF surgery are usually able to return home 1-2 days following surgery.
During the hospital stay, physical and occupational therapists will teach the patient proper techniques for sitting, bending, lifting, getting out of bed and walking. The patient is monitored to ensure that there are no complications such as infection or blood clots in the legs.
Pain medications will be prescribed; these are usually tapered off over the course of two weeks following surgery.
Patients are usually allowed to resume a normal diet right away. Most of the pain after ALIF surgery comes from the abdominal muscle incision. This pain usually significantly improves after the first week.
Back pain is also common in any ALIF surgery when pedicle screws are placed. Many patients return to light duty jobs within two to three weeks after surgery.
Patients in higher impact occupations can expect to return to work after at least three months. Physical therapy is typically prescribed 2-3 months after surgery to help patients regain mobility, strength and flexibility.
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Risks of ALIF Surgery
As with any surgical procedure, certain risks are always present. These risks can be reduced greatly when the surgery is carried out by an experienced, qualified surgeon.
Some of the risks that can be associated with ALIF surgery include:
Damage to adjacent major blood vessels
Large blood vessels run very close to the area that ALIF surgery is performed. These vessels can become damaged, resulting in excessive blood loss. Working with an experienced vascular surgeon and spine surgeon decreases the chance of this complication occurring. If it does occur, the vascular surgeon can repair any holes in these large blood vessels by sewing them closed.
Retrograde ejaculation
For men, the nerve that controls the directional valve for ejaculation is located in the region where ALIF surgery takes place. Damage to this nerve can result in the patient losing function of the valve and experiencing retrograde ejaculation. In such cases orgasm is achievable, but there is no ejaculate. This occurs in approximately 1% of ALIF surgeries in men and typically resolves on its own over time. For men who are planning or considering fathering children in the future, banking of sperm prior to ALIF surgery is a good option just to be on the safe side.
Infection
Infection is always a risk with any procedure. The risk is greatly minimized with proper sterile technique, preoperative antibiotics, and liberal irrigation of the operative field prior to closure.
Nerve damage
Nerve damage is a risk of any spinal surgery. Nerve damage can cause pain, numbness, or weakness and, when it occurs, runs the risk of being permanent; however, permanent nerve damage after ALIF surgery is very rare.
Blood Clots
Any surgery carries the risk of blood clots in the legs but the risk of these is minimized with early mobilization and the use of compression devices.
Non-union
The final step in any successful fusion surgery is for the bones to fuse. This process takes months. Rarely, the bones do not fuse, and if they do not, a revision surgery may be necessary.
Is ALIF Surgery Right for Me?
Determining if ALIF surgery is the best choice for you depends on many factors.
This is why it’s necessary to seek medical advice from an experienced, compassionate and qualified surgeon to assess your spinal care needs.
Depending on the cause of your back pain or leg pain, ALIF may be the perfect fit for you.
About Dr. Alfred T. Ogden
MD, FAANS
Dr. Alfred T. Ogden is an accomplished neurosurgeon in North Jersey and is a proud member of Neurosurgeons of New Jersey, practicing out of their Ridgewood office conveniently located on East Ridgewood Avenue. Dr. Ogden is internationally recognized as a leader in minimally invasive spine surgery.