An ALIF (Anterior lumbar interbody fusion) is a spinal surgery where the spine is approached from the front (anteriorly) rather than from the back. Get to know about ALIF surgery, when this surgery is needed and its advantages and disadvantages, risk factors and outcomes and precautions to be taken post-surgery.
About ALIF surgery
This surgery performed through the abdomen, usually with the assistance of a vascular surgeon to move the major arteries and blood vessels out of the way. The disc is removed and pressure on the nerves can be relieved. A large cage is then placed in the space where the disc was located, and screws are inserted through the cage or a plate and into the spinal bones for extra stability.
ALIF surgery is a well-tolerated procedure and typically is associated with less pain and a faster recovery than spinal fusion surgery performed from the back of the spine. It allows placement of a much larger cage than other types of spinal fusion, which provides more stability and has a higher chance of fusing solidly. It allows better correction of spinal deformity or imbalance, and this may be associated with better long-term outcomes in terms of pain, quality of life, and reduced chance of developing problems at adjacent levels of the spine.
Indications for ALIF surgery
ALIF surgery recommended treating a variety of conditions, such as:
- One or more fractured (broken) vertebrae
- Spinal Instability
- Painful disc degeneration or Protruding discs
- Abnormal curvatures of the spine, such as scoliosis or kyphosis
- Spondylolisthesis (slippage of one vertebral bone over another)
- Spinal deformity or imbalance
Disadvantages of ALIF surgery
Some patients may not be right candidates for ALIF surgery for example if they have had extensive abdominal surgery in the past, are quite obese, or have unsuitable vascular anatomy.
Risks with ALIF surgery
The risks are the same as for other types of spinal fusion, including infection, bleeding, nerve damage, incontinence, blood clots in your legs or lungs, paralysis, stroke and a very small risk of loss of your leg(s) or death. Because the major blood vessels of the abdomen are nearby, there is a risk of major hemorrhage. In men, there is also a small risk of retrograde ejaculation- where the patient ejaculated into his bladder rather than outside. An abdominal hernia is also another potential complication.
How is an ALIF surgery performed?
For an ALIF surgery, the patient is positioned on his or her back and sedated under general anesthesia.
The surgeon then, for a clear view of the front of the spine and access to the vertebrae makes an incision in the abdomen and retracts the abdominal muscles, organs and vascular structures; including such as major blood vessels as the aorta and vena cava. (This part of the procedure may be performed by a vascular specialist or general surgeon)
Then the surgeon removes all or part of the degenerated discs from the affected spinal disc space, and inserts bone graft or bone graft substitute into the disc space between the vertebral bodies, to support the disc space and promote bone healing.
Returns the abdominal organs, blood vessels, and muscles to their normal place, and stitches the incision. You will be in the hospital for between 2 and 4 days after your surgery.
Surgeons commonly perform ALIF surgery as a traditional (open surgery) method as described above; however, another option is to access the spine using a minimally invasive procedure that allows the surgeon to reach the affected vertebrae through tiny incisions and intramuscular tunnels created to accommodate special guidance, illumination, and surgical tools.
Outcomes of ALIF surgery
In well-selected patients, the outcomes are generally quite good. 70 to 80% of patients should obtain a good outcome.
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What else happens after discharge?
You will need to take it easy for 8 weeks but should walk for at least an hour every day. You should avoid sitting for more than 15-20 minutes continuously during this time.
At 6-8 weeks it is likely that you will be able to return to work on “light duties” and to drive a motor vehicle on short trips. This and the step-wise progression in your physical activities will be determined on an individual basis.
Bear in mind that the amount of time it takes to return to normal activities is different for every patient. Discomfort should decrease a little each day. Increases in energy and activity are signs that your post-operative recovery is progressing well. Maintaining a positive attitude, a healthy and well-balanced diet, and ensuring plenty of rest are excellent ways to speed up your recovery.
Signs of infection such as swelling, redness or discharge from the incision, and fever should be brought to the surgeon’s attention immediately.
You will be reviewed after 6-8 weeks by your neurosurgeon. Until then, you should not lift objects weighing more than 2-3kg, and should not engage in bending or twisting movements.
The results of fusion surgery are not as good in patients who smoke or are very obese. It is important that you give up smoking permanently before your surgery and try to lose as much weight as possible.
You should continue wearing your TED stockings for a couple of weeks after surgery.
In summary, before going for surgery consult 2 or more doctors or get a second opinion from the qualified experts can help in many different ways. Since you or your loved ones are the primary stakeholders in any health-related decision, it is your right to know all your options and then take a well-informed decision.
If for some reason an experienced doctor is not available around you, then you can contact us here.
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Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.