Anterior Lumbar Interbody Fusion (ALIF) is a surgical fusion of the lower spine where the spine is approached from the front i.e. through the abdomen. The intervertebral disc is removed and replaced by bone graft and a cage (spacer). The aim of the surgery is to prevent movement between the involved vertebrae and realign the spinal column so as to reduce the back pain and relieve the compression on the nerves.
The anterior lumbar interbody fusion (ALIF) is similar to the posterior lumbar interbody fusion (PLIF), except that in the ALIF, the disc space is fused by approaching the spine through the abdomen instead of through the lower back. In the ALIF approach, a three-inch to five-inch incision is made on the left side of the abdomen and the abdominal muscles are retracted to the side.
About the Surgery
Anaesthesia: The surgery is performed under a general anaesthetic, with the patient lying on the back.
The procedure: A 7-10cm incision is made in the abdomen and the abdominal muscles (rectus abdominis) are retracted to the side. The abdominal contents (intestines) that lie inside a large sack (peritoneum) are retracted to allow access to the front of the spine. The large blood vessels that continue to the legs (aorta and vena cava) lie in front of the spine and have to be moved out of the way to access the spine. After the blood vessels have been moved aside, the intervertebral disc is excised and the resultant space is filled with a cage (made from a plastic substance called PEEK) filled with bone graft. A drain tube may be placed in the wound to remove the blood that collects at the surgical site. The incision is closed with dissolvable sutures.
After the Surgery
In the recovery room: Following surgery, you will be transferred to the recovery room and may feel some pain at the operated site when you wake up. You will be given pain medications, antibiotics, intravenous fluids to keep you hydrated and a urinary catheter will empty your bladder. When you are comfortable you will be transferred to your room.
In the ward: Since the abdomen was opened during surgery, you will be advised not to eat or drink anything for the first 12 -24 hours. You will then be commenced on a clear fluid diet and gradually progress to a light diet. Medications will be provided to reduce your pain after surgery and at home for the first 1-2 weeks. However, if you have excessive pain while you are in the hospital, the attending nurses should be informed. The day after surgery, the drain tube and the urinary catheter will be removed and you will be encouraged to walk wearing a brace to support your spine. You will stay in the hospital for approximately 3-5 days and your surgeon will decide when you can go home.
At Home: Once you are at home, it is important to stay active and take short walks at regular intervals to help reduce pain and hasten your recovery. Gradually increase the distance you walk each day but avoid strenuous activities, heavy lifting and twisting. You may require some help with chores and errands for the first few weeks and it is advisable to have someone to help with these activities.
Advantages of ALIF Surgery :
- The ALIF approach is advantageous in that, unlike the PLIF and posterolateral gutter approaches, both the back muscles and nerves remain undisturbed.
- Another advantage is that placing the bone graft in the front of the spine places it in compression, and bone in compression tends to fuse better.
- Lastly, a much larger implant can be inserted through an anterior approach, and this provides for better initial stability of the fusion construct.
