Anterior lumbar interbody fusion, also called ALIF, is a surgical procedure that is used to treat spinal problems like spinal instability, disc degeneration and deformities of the curves of the spine. In this operation, an anterior incision is made (from the front), and a disc is removed from the lumbar or lower portion of the spine. A bone graft is then inserted into the interbody space, which is the space created between two vertebrae when the disc was removed.
The goal of ALIF is to allow the vertebrae to fuse (grow together) into one solid section of bone. Fusion results in a rigid, stationary column of bone in the section of the spine that was causing pain or other problematic symptoms. The procedure is used in an effort to reduce back pain and other symptoms.
This brief guide will help you know more about:
- what your doctor hopes to accomplish
- what will happen during your operation
- what to expect after ALIF
What parts of the lower back and the spine are involved?
An ALIF involves the anterior longitudinal ligament, which attaches to the front of the spinal column. This is because the procedure is performed through the front or the abdomen. It also involves the vertebral bodies, which are the big bony sections of each vertebra, and the intervertebral discs, which are the cushions that lie between each pair of vertebrae.
What does my surgeon hope to accomplish?
ALIF is often used to relieve symptoms caused by lumbar disc disease. When vertebral discs wear out or degenerate, as a natural consequence of wear and tear due to aging or due to stress and strain, they begin to shrink and collapse. This decreases the space between the vertebrae.
When ALIF is successful, the fused vertebrae move as one unit rather than against each other. This helps reduce pain and prevents additional wear and tear changes on the section of the spine that was fused.
Preparing for ALIF surgery
You and your surgeon will decide together if ALIF surgery is right for you. It’s important that you have a thorough understanding of the procedure and that any questions or concerns you have are answered by your physician.
To ensure you are in good physical condition before an ALIF surgery, your surgeon may recommend you undergo a complete physical examination. This will probably be completed by your general family practitioner.
In most cases, you will arrive at the hospital in the morning on the day of your ALIF surgery. You will probably be instructed not to eat or drink anything after midnight the night before ALIF surgery.
Surgical Procedure of ALIF
What happens during ALIF?
Most often, a general anesthesia is used to put patients to sleep during spinal surgery. During the operation, you may be assisted to breathe. A ventilator is a machine that helps you breathe and monitors your breathing.
During the procedure, you will be lying on your back, with a pad under your lower back. An incision will be made on one side of your abdomen. The soft tissues of the abdomen will be gently separated and held with retractors, and the blood vessels in front of the spine will also be moved aside so the surgeon can see the vertebrae.
A needle will be inserted into the disc and an X-ray will be taken to ensure the correct disc is chosen. The front of the disc will be opened and the vertebrae spread apart to allow the surgeon to see between them. The front half of the disc will then be removed. Sometimes a surgical microscope is used to help visualize pieces of the disc located near the back of the disc space.
A layer of bone is shaved off the flat surface of the two vertebrae causing them to bleed. This bleeding will stimulate healing. The space between the vertebrae is measured (height and depth).
The surgeon then removes a section of bone from the pelvis to use as a graft. It is measured to fit tightly where the disc was removed. A traction device is used to spread the vertebrae apart and the graft is set in place. Then the traction is released.
The graft is tested to make sure it is correctly placed and is firmly locked. Another X-ray may be obtained to ensure the fit and the location of the graft.
A tube may be placed in the wound to allow for drainage and the muscles and soft tissues are put back into place. The skin is then sutured together. You may be placed in a brace to support your spine while it heals.
Complications of ALIF
All major surgery comes with the risk of complications. Some of the complications associated with ALIF may include:
- nerve damage
- blood vessel damage
- problems with anesthesia
- ongoing pain
- blood clots
- problems with the hardware or the graft
- other complications
Problems with Anesthesia
Sometimes problems arise when other drugs the patient is taking causes a reaction to the anesthesia used during ALIF surgery.
Thrombophlebitis (Blood Clots)
Sometimes called deep vein thrombosis or DVT, blood clots can develop after any ALIF surgery. They occur when blood clots form in the large veins of the legs. One of the best ways to prevent them is to get up and moving around as soon as possible after ALIF surgery. Other preventative measures include:
- medications to keep blood clots from forming
- special elastic stockings to help keep the blood in the legs circulating.
Infection after an ALIF surgery is not a common complication, but it can be very serious. An infection can show up shortly after an ALIF or it can appear months or even years later.
When ALIF surgery is performed close to the spinal canal, the potential exists for injury to the spinal nerves or to the spinal cord itself. Injury can be caused by cutting or bumping nerve tissue during ALIF surgery.
Blood Vessel Damage
The surgeon has to move the abdominal aorta (the largest artery in the body) and the large veins close to it during the ALIF procedure. If these blood vessels are injured, internal bleeding may result.
Problems with the Graft or Hardware
In ALIF surgery, bones are grafted into the spine. Most often, the graft is harvested from the pelvis. Pain, weakness or infection are possible in the area where the graft was obtained.
Problems with hardware can also develop. Pins and/or screws can loosen and cause irritation of the soft tissues in nearby areas. Sometimes metal plates break. If this occurs, the surgeon may recommend another ALIF surgery to remove the hardware or to add additional hardware to create stability.
ALIF is a complicated procedure. Not every patient experiences complete pain relief from the operation, but you can expect some relief from your pain. If your pain continues or is unbearable, ask your physician about treatment options to help with pain control.
After ALIF Surgery
After ALIF surgery, sometimes patients need to wear a rigid body brace. If the surgeon used metal hardware to hold the fusion in place, this may not be needed.
Recovery from ALIF
Recovering from ALIF can take some time. Outpatient physical therapy is recommended by many surgeons and usually begins no sooner than six weeks after the ALIF surgery. This is to make sure the graft is fusing before therapy starts. Therapy is typically ordered for at least eight weeks, but full recovery can take up to eight months. Rehabilitation usually progresses faster in patients who have had fusion with instrumentation.
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