RANDALL F. DRYER, M.D.
TOP RATED U.S. SPINE SURGEON
ALIF
Anterior Lumbar Interbody Fusion (ALIF)
The spinal experts at the Central Texas Spine Institute in Austin provide advanced spinal treatments, including the Anterior Lumbar Interbody Fusion (ALIF) procedure, to address lumbar spine conditions and alleviate debilitating symptoms. ALIF is a surgical technique used to treat a variety of spinal disorders by removing a damaged disc from the lower back and fusing adjacent vertebrae to restore stability and relieve nerve compression.
Frequently Asked Questions
When considering the indications for lumbar spine fusion, lower back pain that lasts for more than six months is the most general indication. The indications for fusing the lower back occur primarily in situations where there is a large deformity, such as:
- Mechanical back pain (usually attributed to disc degeneration)
- Spinal stenosis (narrowing of the spinal canal)
- Spondylolisthesis (slippage of one vertebra on another)
- Fractures
- Tumors
- Scoliosis
Diagnostic Tools
- Patient history
- Physical exam
- X-rays, Magnetic Resonance Image (MRI) or CT scan
- Discogram
- EMGs
Treatment Alternatives
- Medications
- Continue to live with condition
- Physical therapy (exercises and stretching)
- Chiropractic manipulation
- Epidural Steroid Injections (ESIs)
- TENS Units
Purpose of Procedure
The primary purpose of this procedure is to stabilize the spine by restoring the disc height and alignment using metal cages and/or pedicle screws. We fuse the vertebrae together using the patient’s own bone or a genetically engineered substance known as Bone Morphogenetic Protein (BMP). Relieving pressure on the nerves may be combined with the fusion by laminectomy.
Bone for Fusion
There are currently two primary alternative sources for the bone needed for the spinal fusion. Traditionally, some of the patient’s own bone has been harvested from the iliac crest (pelvic bone). This technique produces excellent results for the fusion.
Early in 2003, the FDA approved a genetically engineered bone substitute for use in spinal fusions. Under the brand name, InFUSE, BMP converts stem cells into bone-forming cells and stimulates rapid growth of bone at the targeted site. Using this orthopedic stem cell treatment eliminates the need for harvesting the patient’s own bone and speeds up the fusion process.
Using either form of bone graft can yield a high rate of fusion, but neither is 100 percent guaranteed. BMP tends to give better rates of fusion than other graft materials, including pelvic bone.
Advantage of Anterior (Front) Approach vs. Posterior (Back) Approach
In the ALIF approach, a three-inch to five-inch incision is made on the left side of the abdomen, and the abdominal muscles are retracted to the side. Since the anterior abdominal muscle in the midline runs vertically, it does not need to be cut and easily retracts to the side. The abdominal contents lay inside a large sack (peritoneum) that can also be retracted, thus allowing the surgeon access to the front of the spine.
The large blood vessels that continue to the legs (aorta and vena cava) lay on top of the spine, so we perform this surgery in conjunction with a vascular surgeon who mobilizes the large blood vessels. After the blood vessels have been moved aside, the disc material is removed and bone graft, or bone graft and anterior interbody cages, is inserted.
The ALIF approach has the advantage that, unlike the PLIF and posterolateral approaches, both the back muscles and nerves remain undisturbed. Another advantage is that placing the bone graft in the front of the spine places it in compression, and bones in compression tend to fuse more readily. This also allows for the removal of the common source of pain, namely the disc.
However, there is also a major risk that is unique to the ALIF approach: the procedure is performed in close proximity to the large blood vessels that go to the legs. Damage to these large blood vessels may result in excessive blood loss. This is a rare complication.
For males, another risk unique to this approach is that approaching the L5-S1 (lumbar segment 5 and sacral segment 1) disc space from the front has a risk of creating a condition known as retrograde ejaculation. This condition causes ejaculation to go up into the bladder instead of out. The sensation of ejaculating is largely the same, but it makes conception more difficult. Fortunately, retrograde ejaculation happens in less than 1% of cases and tends to resolve in 1 – 2 years.
Who will be involved in the procedure?
Surgeon
The orthopedic spine surgeon who you have been seeing in our office will be the primary surgeon, in charge of your surgery.
Vascular Surgeon/Co-Surgeon
Assistant Surgeon
Another orthopedic spine surgeon, usually from our office, will assist your orthopedic surgeon with the procedure. This is done to minimize the length of time you are under general anesthesia and to provide the necessary assistance with the actual surgical procedure.
Anesthesiologist
The doctor who actually administers and monitors the anesthesia is a critical part of the surgical team. You will normally meet with the Anesthesiologist during your pre-op appointment at the hospital.
Length of Surgery
One to two hours is typical for one and two levels fused anteriorly.
Hospital Stay
With most spinal surgeries, patients are up and walking within hours after their procedure. It is no longer necessary nor recommended that you lie in bed for days or weeks after spine surgery. Nurses who are experienced in working with spinal surgery patients will assist you during your first few efforts at getting out of bed and walking.
Your doctor will tell you when it is safe to shower after surgery. Showers are usually allowed 2-3 days after surgery. Soaking in a bathtub is not allowed.
Nutrition
Liquids are allowed right after surgery. Solid foods are not started for several days. Your doctor will give you specific instructions.
How much pain should I expect and how is it treated?
Your doctor’s goal is to keep you as comfortable as possible. Almost all strong pain medications are narcotics that tend to make you sleepy and can depress your breathing. We must balance the side effects with our goal to relieve pain. In the hospital, (IV) patient-controlled medications are given the first day. We then switch to oral medications. You will have pain pills for home use as well. We continue home medications as needed with the goal of weaning them as you recover. It is important to tell your doctor of any allergies to medicines and to only use pain medications as directed. Mixing medications can be dangerous. We do not refill pain medications after hours or on weekends. You must ask ahead 1-2 days if you are going to run out of pain pills. Refills of medications are at your doctor’s discretion.
Return to Routine of Normal Daily Living
It normally takes approximately 3 to 6 months for the fusion to occur. During that time, you should avoid strenuous activities that might affect the fusion process.
During the rehabilitation process, it is important to recondition the muscles with exercise, stretching, and aerobic conditioning. Your doctor will give more specific instructions during the course of your post-operative care during your office visits.
Driving is not allowed until after your first post-op visit (usually 7-10 days). Most patients are able to go up and down stairs when they go home from the hospital. Some patients may require additional assistance.
Risks and Potential Complications
- Infection
- Bleeding
- Complications from anesthesia
- Continued low back or leg pain
- Fusion may not occur (higher incidence of non-fusion in patients who smoke)
- Hardware (i.e. pedicle screws or cages) may break or come loose
- Numbness
- Nerve damage
- Weakness
- Loss of sexual function
- Infertility
- Death
No Guarantees
No guarantees can be made as to the success of this procedure.
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Who is a candidate for ALIF?
Patients who may benefit from an ALIF procedure typically experience lower back pain, leg pain, weakness, or numbness due to conditions like degenerative disc disease, spondylolisthesis, or spinal instability. Our team evaluates each patient's symptoms, medical history, and diagnostic tests to determine if ALIF is the appropriate treatment option to address their specific spinal condition.
Our Expertise
Our skilled spine specialists at the Central Texas Spine Institute in Austin are committed to providing comprehensive care and personalized treatment plans to ensure optimal outcomes for patients undergoing ALIF. We combine surgical expertise with a patient-centered approach to deliver exceptional results and support individuals through every stage of their recovery process.
CALL TODAY
If you are experiencing chronic lower back pain and seeking a solution that addresses the underlying cause of your symptoms, our team is here to help. Contact us at the Central Texas Spine Institute in Austin to schedule a consultation and learn how ALIF can help restore your spinal health and improve your quality of life.
ABOUT US
One of the top spine surgeons in the country, Dr. Dryer is an active and recognized leader in the medical profession. Our CTSI professional staff is dedicated to providing our patients with attentive, personalized care.
OUR SERVICES
Utilizing the newest techniques and technologies available to resolve the challenges of back and neck pain, CTSI offers state-of-the-art personalized care. We are Texas' leading back specialists.
