Anterior lumbar interbody fusion (ALIF) is a minimally invasive surgical technique that aims to treat degenerative spinal conditions, such as disc degeneration, spinal stenosis, and spondylolisthesis.

By approaching the spine from the front, ALIF avoids disrupting back muscles and offers several advantages over traditional posterior interbody fusion techniques.

This article will explore the indications, techniques, benefits, and risks of ALIF, as well as discuss the potential benefits of additional percutaneous pedicle screw fixation.

Indications

ALIF is typically indicated for patients suffering from degenerative spinal conditions causing chronic low back and leg pain that have not responded to conservative treatments.

This procedure may be recommended for those with conditions such as degenerative disc disease, spinal stenosis, or spondylolisthesis. It is also an option for patients who have undergone previous spine surgery and require a revision procedure.

Technique

During an ALIF procedure, the patient is placed under general anaesthesia and positioned on their back. The surgeon makes an incision in the lower abdomen and carefully moves the abdominal muscles and blood vessels aside to access the front of the spine.

The affected disc is removed, and an interbody cage filled with bone graft material is inserted in the disc space to restore the normal height of the vertebral segment.

Once the interbody cage is in place, the surgeon may opt to perform additional percutaneous pedicle screw fixation to enhance spinal stability. This involves the insertion of screws and rods through small incisions in the back, guided by spinal navigation for increased accuracy and precision.

Benefits

• Minimally invasive: ALIF is performed through a small incision in the abdomen, avoiding the need to disrupt the muscles and soft tissues of the back. Compared to posterior approaches, this results in less postoperative pain and a quicker recovery.
• Preservation of spinal muscles: Since ALIF does not involve cutting or retracting the back muscles, it preserves their function and reduces the risk of postoperative muscle atrophy and pain.
• Better access to the disc space: Approaching the spine from the front allows the surgeon to access the affected disc more directly, resulting in a more complete disc removal and more precise placement of the interbody cage.
• Reduced risk of nerve damage: ALIF reduces the risk of nerve damage by avoiding manipulation of the spinal nerves during surgery.
• Enhanced spinal stability with pedicle screw fixation: The addition of percutaneous pedicle screw fixation can further stabilise the spine and promote successful fusion without the need for more invasive techniques.

Risks

As with any surgical procedure, ALIF carries potential risks, including infection, bleeding, blood vessel or nerve injury (this technique is sometimes avoided in young men for this reason), and nonunion or pseudarthrosis (failure of the vertebrae to fuse).

However, the overall risk profile is generally lower than traditional open posterior fusion techniques.

Anterior lumbar interbody fusion (ALIF) is a minimally invasive approach to spinal stabilisation that provides several advantages over traditional posterior techniques. With its reduced disruption to spinal muscles and lower risk of nerve damage, ALIF is becoming an increasingly popular choice for patients seeking relief from chronic lower back pain caused by degenerative spinal conditions.

The addition of percutaneous pedicle screw fixation further enhances spinal stability and promotes successful fusion. As surgical technologies and techniques continue to advance, ALIF is expected to remain at the forefront of spine surgery, offering patients a safer and more effective treatment option for debilitating spinal conditions.