Anterior Lumbar Interbody Fusion
Motion of the vertebrae of the spine. Spinal fusion is essentially a process that welds the bones together stopping painful motion across the disc and facet joints. It joins the vertebrae together making him a single solid bone. Spine fusion in general is a treatment option for arthritis-related to slipping of the bone (spondylolisthesis), curvature of the spine(scoliosis), vertebral body fracture or after failed treatment for disc herniation and foraminal stenosis. This page will focus on anterior lumbar interbody fusion and discuss the surgical components of the procedure.
Overview and indications for surgery
ALIF utilizes an anterior incision through the abdominal region usually below the umbilicus. ALIF may be performed with or without posterior laminectomy or instrumentation with pedicle screws and rods. The anterior lumbar ALIF approach involves retracting large blood vessels and the intestines. This approach allows a wide exposure of the intervertebral disc without retraction of the spinal nerves and neurological structures so there is less risk of neurological injury. The endplates of the disc space are relatively flat and large which gives us our best large surface area for bone fusion healing. ALIF is commonly performed for a variety of painful spinal condition such as spondylolisthesis, scoliosis, fracture, degenerative disc disease as well as others.
ALIF surgery is performed using general anesthesia and a breathing tube (endotracheal airway). The patient is positioned in the supine lying position. Sterile drapes and sterile surgical attire maintain the bacteria free sterile environment. A midline incision either up-and-down or low along the pubis may be used depending on the number of spinal levels to be fused. The muscles are gently spread apart but are not cut. The peritoneal sac containing the intestines is retracted to the side as are the large blood vessels. Special retractors were used that allows us to visualize the front of the intervertebral disc. An x-ray confirmed the appropriate spinal level has been accessed.
The intervertebral disc is removed using instruments such as a pituitary rongeur, Kerrison rongeurs, and curettes. Specimen insertion instruments were used to size the disc space height and to choose the appropriately sized cage or spacer for the disc space. Fluoroscopic x-rays are taken to confirm the position and height of the spacer is correct. After the surgery is completed the wound is irrigated with sterile solution and the wound is closed in layers with strong sutures and the skin is closed with subcuticular stitches leaving a minimal scar. The total surgery time is usually 2 or 3 hours depending on the number of spinal levels involved.
Most patients are able to go home the following morning occasionally people will go home as an outpatient the same day. Patients tend to stay a little longer if a posterior spinal surgery is also performed. Physical therapist will work with the patient to instruct him on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending and twisting at the waist and lifting more than 5 pounds. A walking program every day is very helpful for recovery. Patient will gradually begin to bend and twist and lift more after 1 to 2 months as the pain subsides and the muscles get stronger. A back brace is not absolutely necessary but a lumbar corset can provide additional lumbar support in the postoperative period. The wound area can be left open to air and no bandages should be required. The area should be kept clean and dry. The patient may shower after surgery within 24 hours. The wound should not be completely submerged such as in a bathtub or swimming pool for at least 2 weeks after surgery. Driving may begin when the pain is diminished to a mild level and the patient is no longer taking narcotics. Patient should not drive while taking narcotics. When driving for the first time it should be a short drive and have someone with you in case the pain flares up and they need help driving home. Once driving safely, one may begin driving longer distances.
Return to work and activities
The patient returns to light duty as early as 2 or 3 weeks after surgery depending on when the pain is subsided. Moderate level work and light recreational activities as early as 3 months after surgery and patient who has undergone a fusion at only 1 level may proceed to heavy lifting and sports activities once they have completed their physical therapy or walking training.
Follow-up visits the patient will return to see the doctor at least at 1 month, 3 months, and 6 months. At 8-12 weeks after surgery, the patient may be recommended for physical therapy as needed.
The results of anterior lumbar interbody fusion ALIF are quite good. The procedure is associated with 87-97% good and excellent results. The patient should have significant improvement of back pain and return to most normal daily and recreational activities.