Anterior Lumbar Interbody Fusion
What is Anterior Lumbar Interbody Fusion?
An Interbody fusion is another type of spine fusion that involves removing the intervertebral. There are a couple different approachs to this surgery, for example, Dr. Girardi can access the spine through incisions in the lower back, or he can make the incision on the side. In an Anterior Lumbar Interbody fusion (or ALIF), Dr. Girardi will approach the lower back from the front through an incision in the lower abdomen.
Why Would I Need An Anterior Lumbar Interbody Fusion?
Most spinal surgeries are performed with a back approach, your surgeon may choose an anterior approach for a number of reasons, including:
- To avoid multiple surgeries in one area if you have already had previous spinal surgeries using a posterior (back) approach.
- To allow more direct access to the intervertebral disk.
- To have the ability to add more lordosis (swayback) to your spine.
- Your recovery may be quicker.
In contrast, when your surgeon uses an anterior approach he or she can access your spine without moving the nerves. Organs and blood vessels must be moved to the side with an anterior approach, however, More than likely, a vascular surgeon will need to assist the orthopedist with opening and showing the disk space.
Is ALIF Surgery Better Than Disc Replacement Surgery?
For patients who have been suffering from serious low back pain for at least six months and aggressive nonsurgical treatments have not been successful, there are basically two options to relieve the pain — spinal fusion or artificial disc replacement.
Which is the better option?
Dr. Girardi will discuss this with you at length during your consultation, but here is information on both options.
Anterior Lumbar Interbody Fusion:
ALIF and other fusion options are far and away the most prevalent surgical methods in these cases. Many patients are not eligible for disc replacement due to instability of the spine from scoliosis or ankylosing spondylitis, degeneration of the vertebrae due to osteoporosis, or other problems with the facet joints at the back of each vertebrae.
Lumbar fusion stiffens the area where the two vertebrae are fused. This was the goal — to limit motion between the two vertebrae that was impacting the spinal cord or nerve roots exiting the spinal cord. However, limitation of mobility at the fusion site is a side issue of this surgery option. Of course, the patient likely had severely limited motion prior to the surgery, due to the pain it caused, so motion can actually increase even with fusion once the pain is gone. The limitations of motion are less of an issue if the last lumbar vertebra, L5, is fused into the first sacrum segment, S1.
Lumbar fusion doesn’t always relieve the pain. Various clinical studies have rates of success rates around 80 percent for successfully improving pain postoperatively. The location of the fusion impacts this, with best results at L1-S1.
Another factor with lumbar fusion is the stress it places on the vertebrae and spinal discs above and below (if not entering the sacrum) the fused vertebrae. This is sometimes called adjacent segment disease, but it hasn’t been verified with research showing a specific correlation. The degradation could have happened without the fusion, so cause and effect hasn’t been proven at this point.
Artificial disc replacement:
Artificial disc replacement is a relatively new procedure. The FDA approved the first artificial discs in 2000. This surgery had been done in Europe for another 15 years prior to that. Because of that relatively short period of time, there aren’t any long-term studies on the success of these procedures. That doesn’t necessarily mean they are good or bad, but there just isn’t data to see how the implanted artificial disc and the metal implants on top and bottom will hold up over time.
There are currently four approved artificial discs in the U.S. Each implant design produces different motion patterns in the patient. They don’t replicate normal spinal movement, but they do allow movement. There have been reports that patients who have had artificial disc replacement have accelerated posterior facet joint degeneration, which is thought to be caused by the abnormal motion provided by the artificial disc. But there isn’t research at this point to verify this. Nor is there research to show the potential long-term benefits of maintaining spinal motion with artificial disc replacement and this leading to less degeneration and problems with surrounding discs. That is a theoretical benefit of disc replacement, however.
The Anterior Lumbar Interbody Surgical Procedure
The ALIF procedure is perform under anesthesia with the patient lying face up on an operating table. Most Interbody Fusions take 2-3 hours.In the first part of the procedure, your surgeon will remove the intervertebral disk from the disk space. When the disk space has been cleared out, he or she will implant a metal, plastic, or bone spacer between the two adjoining vertebrae. Afterwards, a special spacer called a “cage” will be used to help promote bone healing and facilitate the fusion of the disk. Once Dr. Girardi places the cage in the disks space, he may need to stabilize your spine with either a plate or screw to hold the cage in place. You may want to consult Dr. Girardi to make sure that this surgery is right for you.
How Many Years Does A Spinal Fusion Last?
Once the two vertebrae have successfully fused, they become a single piece of bone. They will remain this way for the rest of the patient’s life.
Is Spinal Fusion Surgery Painful?
You will have pain medication in the hospital during your stay of 2-3 days. From there, you will move home or to a rehabilitation facility and you will transition to prescription pain medication. There is usually no need for further use of opioid pain medication after 2 to 3 weeks. In most cases, the worst pain is over after at most 4 weeks after surgery. Although your pain will decrease, some patients can continue to have some amount of pain for 3 to 6 months after surgery. This varies dramatically with different patients.
Dr. Girardi does stress to his patients during their consultations that, while there will be pain during your recovery, these procedures are very successful in eliminating the chronic pain you’ve been enduring that created the need for ALIF surgery in the first place.
What Kind Of Recovery Should I Expect From Anterior Lumbar Interbody Fusion
Patients usually have a smooth recovery from ALIF. After the procedure, they normally remain in the hospital for 3 to 5 days and are able to resume their activities after 6 to 8 weeks. For About 8 weeks, patients should refrain from bending over and going up and down. At a physical therapists office, you will perform basic exercises, including walking and moving. Most patients can expect drastic improvements following their ALIF.
When Can I Return To Work After ALIF Surgery?
Recovery after ALIF surgery with Dr. Girardi can vary widely by the patient. Your healing rate can affect the speed of your progress. How long before you can return to work also depends upon the type of work you do. Lifting, twisting, and bending with your back will be out of the question for at least 8 weeks. Initial healing needs between 3-6 weeks before you do much of anything other than walking. Complete fusion between the two vertebrae takes from 3-6 months. If your work is sedentary, you may be able to return to work in 8 weeks.
Dr. Girardi will discuss your timelines as he sees you for follow-up appointments. That’s when he will be able to ascertain how your healing is progressing.
What Are The Risks Involved With ALIF Surgery
These are major surgeries and they involve the typical associated risks: infection, reaction to anesthesia, excessive bleeding, poor wound healing, and the like. Postoperative wound infection is the most common complication, occurring in between 1-5 percent of cases. The higher risk comes when metal fixation is used. It is also more common in diabetic and overweight patients.
The main risk of ALIF surgery is failure for successful fusion of the two vertebrae. Fusion success rates runs around 90-95 percent, but they are lower in patients who have had prior lower back surgery, smoke, are obese, have multiple levels fused, or have been treated with radiation for cancer. Unsuccessful fusion usually dictates a second procedure.
At a Glance
Dr. Federico Girardi MD
- Triple fellowship-trained spinal surgeon
- Performs over 400 spinal surgeries per year
- Professor of orthopedic surgery at Cornell University
- Learn more