Anterior Lumbar Interbody Fusion
What is an Anterior Lumbar Interbody Fusion (ALIF)?
Remember that your spine isn’t a true vertical line. Instead, the hollow of your back is known as lordosis; and, the gentle stoop of your thoracic spine is known as kyphosis. Yet, when viewed from dead on, your vertebrae appear to stack up perfectly.
If any part of your spine curls away from this midline, then you might have scoliosis. Likewise, if the dip of your lumbar spine becomes too extreme, then you might have hyperlordosis. And, if your shoulders start to slump too far forward, then you might have kyphosis.
Unfortunately, all of these problems can cause significant pain and day-to-day limitations. Patients with >40 degrees of curvature may experience:
- Pain in the neck or lower back
- Leg pain or posture changes that interfere with walking
- Noticeable deformities, like a rib or upper back hump
- Pinched nerves or slipped discs
- Heart, lung, or bladder issues
- Depression or anxiety
Sound a little too familiar? Then, you might need an ALIF to help you find relief.
What is Removed During an ALIF Procedure?
Like the PLIF, an ALIF uses spinal fusion to fix the curvature of the spine. However, unlike a PLIF, the ALIF approaches your spine from the anterior (or front) of the spine. (This is actually what the “A” in ALIF stands for.)
But, what about some of those other letters?
The “L” in ALIF can be a little bit tricky. The “L” means lumbar. However, thanks to advances in surgical technology, your surgeon can now carry out this procedure on your thoracic spine as well. If you need the thoracic form of this surgery, then your doctor will access the front of your spine by:
- Removing a single rib
- Briefly collapsing the left lung (just for the length of the procedure)
- Gently moving the diaphragm to the side and away from the spine
Otherwise, your doctor will expose your spine by creating a 3 to 5-inch incision on the lower, left-hand side of your abdomen. Because your abs (aka, your rectus abdominis) easily pull back, your doctor can spare your abdominal muscles from incision.
Next, your surgeon will carefully move any blood vessels that rest against the spine over to the side. Because this part involves some of the largest veins in your body–the aorta and vena cava–a vascular surgeon may be called on to assist.
Keep in mind that spinal disorders, such as scoliosis or kyphosis, place extreme pressure on the spine. This can lead to ruptured discs or pinched nerves. Therefore, with your spine now fully exposed, your doctor will remove any damaged or herniated discs. At this time, your doctor will also decompress any pinched nerve roots. If your surgeon removes any discs, then he or she will use an implant to fill the disc space.
How Does the Fusion Process Work During an ALIF?
If you have severe scoliosis, kyphosis, or spondylolisthesis, then your doctor will use hooks, rods, or screws to realign your spine. Specifically, your surgeon will add these clasps to the vertebrae above and below the fusion site. These metals devices will support your spine as it heals through the recovery process.
With this hardware in place, your surgeon will begin the fusion part of the spine surgery. To achieve this, your surgeon will insert a bone graft into the interbody space. (The interbody space, or the “I” in ALIF, is the space that lies between two vertebrae.) This bone graft can be sourced from the patient’s hip (an autograft) or from a donor supply (an allograft). On rare occasions, synthetic materials may be used, but these grafts tend to be less effective. Furthermore, if you have osteoporosis, then your surgeon may choose to add a special protein to your graft. This protein encourages the growth of strong bones.
Your surgeon can either deliver this tissue directly into the disc space or use a cage. (A cage is a slatted device with bars, through which the bone tissue can grow.)
As your bone graft matures, your target vertebra will fuse to the adjacent vertebra(e). Your surgeon may choose to complete this process once, or on multiple vertebrae. However, the end result is a spine that straighter, stronger, and more durable.
What are the Advantages of an ALIF?
If possible, your doctor will choose an ALIF (frontal entry) over a PLIF (the posterior approach) or use a combined method. In comparison to the PLIF, however, the ALIF offers:
- Less Trauma: Because your surgeon will access your spine through the abdomen, the thick muscles of your back will not be disturbed. This means less scarring, blood loss, and postoperative pain.
- Compression: The front side of your spine naturally compresses any implants that your surgeon will use. This encourages faster healing and more effective fusion. In addition, the front of your spine can hold larger implants than the back side.
- Less Nerve Involvement: The ALIF does not require your surgeon to remove the lamina, which houses your spinal cord. Less interference with your spinal cord reduces the risk of nerve complications after spinal surgery.
- Speedy Recovery Times: Because this procedure involves less need for incisions, you can resume your day-to-day activities in no time!
Do you need an ALIF to fix the curvature of your spine? Dr. Jason Lowenstein, scoliosis expert, uses minimally invasive surgical treatments to reverse back pain and have you feeling your best again!
Do I Qualify for an Anterior Lumbar Interbody Fusion?
You may need an ALIF if you have:
Scoliosis: If you have >40 degrees of scoliosis and your condition did not improve with bracing. This method can be used for all types of scoliosis, including pediatric scoliosis.
Kyphosis: If you have >40 degrees of kyphosis. This includes kyphosis that results from degenerative disc disease. (Note: Your surgeon may perform an ALIF in conjunction with an osteotomy to correct your kyphosis)
Lordosis: If you have >40 degrees of swayback, aka hyperlordosis.
Spondylolisthesis: If you have a vertebra that has slipped more than 50% forward over the vertebra beneath it.
Disc Problems: If your spinal deformity caused the discs in your back to bulge or rupture.
Unfortunately, an ALIF isn’t for everyone. You may not qualify if you have or have had:
- Severe osteoporosis or weak bones
- Compression fractures
- Spinal Tumors
- Scarring from previous abdominal surgeries
To find out if you qualify for an ALIF, contact Dr. Jason Lowenstein, MD today! Dr. Lowenstein is a fellowship-trained scoliosis surgeon with over a decade of surgical expertise. Because you deserve only the best, contact one of NJ’s top-rated spine surgeons today!