Anterior Lumbar Interbody Fusion (ALIF)

When it comes to Anterior Lumbar Interbody Fusion, New Jersey spine surgeon, Dr. Joshua Rovner, understands what a life-changing procedure it can be. Living with chronic pain can be debilitating and at Progressive Spine & Orthopaedics, we can help you achieve a wider range of motion while permanently relieving pain.

When back pain has become unsolvable and other treatments have been explored, Anterior Lumbar Interbody Fusion (ALIF) is a potential answer that can help to greatly reduce pain and align the bones. ALIF, or anterior lumbar interbody fusion, is a surgery performed to treat disc problems in the low back. Fusion locks together two or more bones to correct the bone alignment and stop painful motion.

What is Anterior Lumbar Interbody Fusion?

Anterior Lumbar Interbody Fusion (or ALIF) is a spinal operation that approaches the target areas from the front, rather than the back. The degenerated disc is removed through an incision in the front of the belly, and a bone graft is placed in the empty space to restore height and relieve nerve pinching. As the body heals, the bones fuse into one solid piece.

Types of bone grafting

During ALIF, materials are placed within the remaining disc space to act as a bone graft which can be thought of as a kind of mortar between the bones. There are several different types of bone grafts, which your surgeon will discuss with you ahead of time. The best option for your particular needs will be chosen.

Autograft

This is a graft from your living bone, whose marrow contains bone-growing proteins. The graft can be collected from drillings during the surgery or taken from the hip. The harvested bone is about half an inch thick.

BMA (bone marrow aspirate)

This is your living bone marrow, collected with a syringe from the hip or vertebra.

Allograft

This is bone from an organ donor, which is collected and stored by a bone bank. The donor graft has no bone-growing cells.

Cellular bone matrix

This is bone from an organ donor that contains bone-growing stem cells.

What conditions can ALIF treat?

ALIF can treat a variety of painful back conditions, including the following:

Spondylolisthesis - Lower back pain caused by a vertebra slipping out of place onto the vertebra below it, which kinks and compresses the nerves.
Degenerative disc disease - The drying and shrinkage of discs with age, which causes the vertebrae bones to rub and pinch the nerves.
Spinal stenosis - The narrowing of the spinal canal and nerve root canals, which pinches the nerves and causes pain and numbness in the legs.
Scoliosis - An abnormal curve of the spine caused by misalignment of the bones due to age, arthritis, or previous spine surgery.

AP and lateral views of an L5-S1 ALIF

Who is a candidate for ALIF?

Candidates for ALIF include the following:

Are generally healthy without serious medical concerns
Do not smoke
Have degenerative disc disease, spondylolisthesis, scoliosis or flat back syndrome
Have symptoms that have not improved with physical therapy or medication
Have not had extensive abdominal surgery in the past
Are not obese
Have healthy vascular anatomy
Have no conditions that would prevent bone fusion
Do not have severe osteoporosis

Am I a Candidate? - Dr. Rovner Answers

What happens during the procedure?

Before the surgery behind, you will be put under general anesthesia. Once this is complete, a skin incision is made on the lower aspect of your belly. The abdominal wall muscles are not cut, but are moved out of the way to expose the spine.

At this point in the procedure, before removing the diseased and herniated disc, an x-ray will be taken to confirm that the operation is being done at the correct level. When this is confirmed, the compressed discs that are pressing on your nerves will be removed.

The space that is left will be filled with bone graft material and a metal or plastic cage.

The bone graft will help this level to fuse, while the cage will indirectly decompress your spinal cord and nerves by keeping the disc space open, which relieves pressure and gives the spinal cord and nerves more room.

The muscles that were moved aside will now be allowed to go back into their normal position, and absorbable sutures will be used to close your wound.

This surgery generally takes 2 to 3 hours, depending on how many spine levels are treated.

Benefits of ALIF

ALIF provides a number of benefits for patients who suffer from unresolved back pain. Benefits include the following:

ALIF is typically is associated with less pain
Includes a faster recovery than spinal fusion surgery performed from the back of the spine
Allows placement of a much larger cage than other types of spinal fusion
Provides more stability
Allows better correction of spinal deformity or imbalance
May have better long term outcomes in terms of pain, quality of life, and complications

Recovery after ALIF

After ALIF, you will remain in the hospital between 2 and 4 days after your surgery. You may return home for the remainder of your recovery, which will take 6 to 12 weeks. We will provide detailed instructions for you that include physical restrictions, how to best care for your wound, and directions to help you ensure an ideal outcome. Important points to keep in mind:

Do not lift objects weighing more than 5 pounds
Do not bend or twist your back
Do not engage in strenuous activity of any kind

Most patients are able to get up and start moving around within several hours of surgery. We encourage you to move around to keep circulation normal, which avoids blood clot formation in the legs. Avoid sitting for more than 15-20 minutes continuously during this time.

We recommend walking for at least an hour in total per day. You can gradually reduce your pain medication over the following weeks. After 6-8 weeks, you will likely be able to return to light work and drive on short trips.

Recovery to return to normal activities varies from patient to patient. You will slowly gain more energy and be able to participate in more activities. Be sure to eat well and get plenty of rest while you’re healing.

FAQs

What can I expect after surgery?

After surgery you will be transferred to the recovery room where you will rest until you have awaken from the anesthesia. You will then be transferred to your hospital room, which is typically when your family members can visit.

Will there be physical therapy?

In the hospital, there will be physical therapy either the same day or the following morning after surgery.

When can I leave the hospital?

Most patients go home within 2-4 days after their surgery, although some spend only about a day in the hospital. You will be discharged once your pain is controlled, you’re tolerating a diet, and you’ve had physical therapy.

How long will it take until I’m fully recovered?

Recovery after ALIF surgery generally takes 12 weeks until you’re feeling back to normal. Internal healing will continue for up to one year as the bones continue to fuse together.

When can I return to work and other activities?

Most patients can return to a light, sedentary desk job or simple household activities within 2-3 weeks of their ALIF surgery.

How long will the surgery take?

Your surgery will take between 2-3 hours.

Will there be a lot of pain after surgery?

Every individual responds to pain differently. You will be in some amount of pain, but this is manageable with IV and oral pain medications.

Can I walk after surgery?

We encourage you to walk as soon as you wake up. During your hospital stay, a physical therapist will work with you to help you walk and move more easily.

Can I remove my dressing after surgery?

Dr. Rovner would like you to keep your dressing in place for two weeks until he sees you again for a follow-up procedure. Keeping your dressing in place minimizes your chance of infection.

Can I get my dressing wet after surgery?

You may shower, but keep your incision out of the direct stream of water. Do not bathe or swim.

Can I drive or fly after surgery?

You may fly, but wait until you are off all narcotics and feel very comfortable before trying to drive again.

Why choose Dr. Rovner?

Dr. Joshua Rover is an award-winning, board-certified spine surgeon. Dr. Joshua Rovner is one of a few spine surgeons in New Jersey with the depth of experience and expertise for advanced spinal surgery, such as ALIF. Dr. Rovner provides both non-surgical and surgical treatment of pain related to the neck and entire back. His approach centers around the needs of his patients, and his personalized care includes careful diagnosis, precision treatment, and a wide range of treatments and surgical procedures to greatly decrease or eliminate pain and improve quality of life. Dr. Rover’s focus is conservative non-surgical methods, but when surgery is necessary, he expertly utilizes the most modern techniques.

If you are suffering from back or neck pain, it is crucial for you to receive a professional diagnosis and surgical plan as soon as possible. Call today for a consultation.