ALIF (Anterior Lumbar Interbody Fusion)

⚙️What This Procedure Involves

An incision is made in the lower abdomen (or a retroperitoneal flank approach). The abdominal contents are carefully moved aside to access the front of the lumbar spine. The disc is completely removed under direct vision. A large cage filled with bone graft is inserted. The procedure is often combined with posterior pedicle screw fixation (placed in a separate stage or during the same anaesthetic). An access surgeon (vascular or general surgeon) assists with the approach. The operation takes two to three hours.

💡Why It May Be Recommended

ALIF is recommended for L4/5 and L5/S1 disc degeneration, spondylolisthesis, failed previous posterior surgery, and when a large interbody device is needed for sagittal balance correction. The anterior approach provides excellent disc space access and allows placement of the largest cage of any fusion technique.

⚖️Non-Operative Alternatives

Physiotherapy, pain management, epidural injections, and activity modification. TLIF, XLIF, and posterior fusion are surgical alternatives.

📋Preparing for Surgery

MRI and CT for planning. Vascular imaging (CT angiogram or MR angiogram) to assess vessel anatomy. An access surgeon is involved in planning.

✅Expected Benefits

Excellent disc space restoration and fusion rates exceeding 95%. The large cage provides strong structural support and indirect foraminal decompression. Avoids disruption of the back muscles.

⚠️Common Risks

• IleusExpected

  Temporary slowing of bowel function from abdominal retraction. Very common and resolves.

• Abdominal discomfortExpected

  From the surgical approach.

• Retrograde ejaculationUncommon

  In men, damage to the superior hypogastric plexus can cause retrograde ejaculation. Risk approximately 1–3% at L5/S1.

🔴Less Common but Serious Risks

• Vascular injuryRare

  The great vessels (aorta, vena cava, iliac vessels) are directly adjacent. Injury is rare with experienced access surgeons but potentially life-threatening.

• Ureteral injuryRare

  The ureter may be damaged during retraction.

• Non-fusionUncommon

  Despite the large cage. Risk approximately 5%.

• Sympathetic chain damageUncommon

  Warm leg or temperature regulation changes.

• Incisional herniaUncommon

  Through the abdominal wound.

• Adjacent segment diseaseLong-term

  Long-term.

💉Anaesthetic Considerations

General anaesthesia. Supine position. An access surgeon manages the approach.

🏃Recovery and Rehabilitation

Hospital stay two to four days. Diet advances gradually as bowel function returns. Walking from day one. BLT restrictions for six to twelve weeks. Return to desk work at four to six weeks. Full fusion six to twelve months.

📅Follow-Up

X-rays at six weeks, three months, and six months. CT scan at one year if fusion uncertain.

❓Frequently Asked Questions