What is it?
Anterior Lumbar Interbody Fusion (ALIF) is a back surgery that involves approaching the spine through an incision in the abdomen. A portion of the affected disc space is removed from the spine and replaced with an implant. Titanium or stainless steel screws and rods may be inserted into the back of the spine to supplement the stability of the entire construct.
What parts of the spine and low back are involved?
ALIF surgery is performed through the front (anterior). The structures in this area include the anterior longitudinal ligament, the vertebral bodies, and the intervertebral discs. The anterior longitudinal ligament attaches along the front of the spinal column. The vertebral bodies are the large blocks of bone that make up the front section of each vertebra. The intervertebral discs are the cushions between each pair of vertebrae.
Why is it done?
Patients who are suffering from back and/or leg pain are potential candidates for the ALIF procedure. This pain is generally caused by natural degeneration of the disc space.
Discectomy is the removal of the disc (and any fragments) between the vertebrae that are to be fused. Taking out the painful disc is intended to alleviate symptoms. It also provides room for placing the bone graft that will allow the two vertebrae to fuse together. The medical term for fusion is arthrodesis.
Once the disc is removed, the surgeon spreads the bones of the spine apart slightly to make more room for the bone graft. The bone graft separates and holds the vertebrae apart. Enlarging the space between the vertebrae widens the opening of the neural foramina, taking pressure off the spinal nerves that pass through these openings. Also, the long ligaments that run up and down inside the spinal canal are pulled taut so they don't buckle into the spinal canal.
The surgeon makes an incision in the patient's abdomen to access the spine. To have a clear view of the spine, the surgeon then retracts the abdominal and vascular structures.
Once the spine is in view, the surgeon removes a portion of the degenerated disc from the affected disc space.
How will I prepare for surgery?
The decision to proceed with surgery must be made jointly by you and your surgeon. You should understand as much about the procedure as possible. If you have concerns or questions, you should talk to your surgeon.
Once you decide on surgery, your surgeon may suggest a complete physical examination by your regular doctor. This exam helps ensure that you are in the best possible condition to undergo the operation.
On the day of your surgery, you will probably be admitted to the hospital early in the morning. You shouldn't eat or drink anything after midnight the night before.
What happens during the operation?
Patients are given a general anesthesia to put them to sleep during most spine surgeries. As you sleep, your breathing may be assisted with a ventilator. A ventilator is a device that controls and monitors the flow of air to the lungs.
The patient is positioned on his or her back with a pad placed under the low back. An incision is made through one side of the abdomen. The large blood vessels that lie in front of the spine are gently moved aside. Retractors are used to gently separate and hold the soft tissues apart so the surgeon has room to work.
The surgeon inserts a needle into the disc. By taking an X-ray with the needle in place, the correct disc is identified. Forceps are used to open the front of the disc. Next, a tool is attached to the vertebrae to spread them apart. This makes it easier for the surgeon to see between the two vertebrae. A small cutting tool (a burr) is used to carefully remove the front half of the disc. A special surgical microscope may be used to help the surgeon see while removing pieces of disc material near the back of the disc space.
The surgeon shaves a layer of bone off the flat surfaces of the two vertebrae. This causes the surfaces to bleed. Bleeding stimulates the bone graft to heal and join the bones together. The surgeon measures the depth and height between the two vertebrae. Making a separate incision, the surgeon takes a section of bone from the top of the pelvis to use as a graft. The graft is measured to fit snugly in the space where the disc was taken out. The surgeon uses a traction device to spread the two vertebrae apart, and the graft is tamped into place.
Traction is released. Then the surgeon tests the graft by bending and turning the spine to make sure the graft is in the right spot and is locked in place. Another X-ray may be taken to double check the location and fit of the graft.
Most surgeons apply some form of metal hardware, called instrumentation, to prevent movement between the vertebrae. Instrumentation protects the graft so it can heal better and faster. One option involves screwing a strap of metal across the front surface of the spine over the area where the graft rests. A second method involves additional surgery through the low back, either on the same day or during a later surgery. In this operation, metal plates and screws are applied through the back of the spine, locking the two vertebrae and preventing them from moving.
What might go wrong?
As with all major surgical procedures, complications can occur. Some of the most common complications following ALIF include
- problems with anesthesia
- nerve damage
- blood vessel damage
- problems with the graft or
- ongoing pain
This is not intended to be a complete list of possible complications.
After the surgery, the patient will normally stay in the hospital between 2 to 5 days. The specific time of stay in the hospital will depend on the patient and the surgeon's specific post-operative treatment plan. The patient will normally be up and walking in the hospital by the end of the first day after the surgery. Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible.
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