ALIF is a minimally invasive treatment for patients who primarily have discogenic back pain.
The aim of this procedure is to obtain solid lumbar fusion to treat back pain by using an anterior approach (operating from the front of the spine) without disturbing or violating the back muscles, their nerves and blood supply which can lead to more back pain and leg pain. Spinal disc degeneration and micro-instability of the lumbar spine can cause mechanical back pain, buttock, groin and hip pain, and nerve root irritations resulting in leg pain. This procedure is designed to stabilize the spine by achieving higher fusion rates to relieve back pain and their associated symptoms, without interfering with nervous tissues thereby avoiding scar formation around nerve roots.
-Small incisions mean less blood loss, less pain, less scarring, and shorter recovery times
The anterior approach avoids damage to the thick and strong posterior muscles of the back
The anterior placement of the fusion has proven to be more successful than the posterior
Little to no manipulation of the spinal nerves leads to less chances for permanent damage
The location of the fusion allows for the natural compression of the spine to aid in healing
Minimally invasive procedures allow for less pain, shorter hospital stays, and a faster recovery.
As with any spinal surgery, the risks include:
Bleeding from blood vessels
Nerve injury causing leg pain, weakness and numbness, or urinary and defaecation problems
Retrograde ejaculation/infertility in men
Complication related to instruments
Blood clot in the legs (deep vein thrombosis), and pulmonary embolism
Under general anesthesia and through a miniopen approach, the surgeon makes a small incision, usually on the left side of the lower abdomen, to expose the front part of the spine by going around the back of the abdominal cavity along the back wall without having to go through the abdominal cavity or cut through any of the back muscles. After disc material is removed from the front of the spine, a synthetic cage with bone graft and screws are inserted into the empty disc space and bone to support, stabilize and create lumbar fusion, and at the same time restoring disc height and spinal alignment into its natural lumbar curvature. Surgery usually takes about 2 to 3 hours to perform for a one or two-level procedure.
Some individuals may be fitted for a brace before surgery. This brace is an important part of your recovery process. Your therapist and doctor may also prescribe several types of medical equipment to help you in your recovery. You may travel home from the hospital by car, either reclining in the front passenger seat or lying down in the back seat. Please stop taking aspirin and nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen and indocin, two weeks before your surgery. If you aren't sure which of your medications are nonsteroidal anti- inflammatory medicines, check with your doctor or pharmacist. Once your NSAIDs are discontinued, you may take extra-strength Tylenol for pain relief. If this does not relieve your pain, call your doctor for other pain relieving medicine. If you take aspirin or Coumadin for a heart condition, please contact your doctor for further instructions. On the day of surgery, please bring a list of your routine medications with you to the hospital. If you smoke, it is important that you stop smoking for at least two weeks before your surgery and for six weeks after your surgery. Studies have shown that smoking interferes with healing of your bone graft.
In most cases, you will stay in the hospital from 1 to 3 days following ALIF. The length of your stay will depend upon how well-controlled your pain is and your ability to stand and move around. Most patients are encouraged to stand and walk by the first day after surgery. Your surgeon may provide you with a back brace to help make you more comfortable and to protect the surgical fusion. You will perform basic exercises, including routine walking, during the first several weeks after surgery. During this time, it is important to avoid bending with your back, twisting, or lifting anything heavy. Most patients who undergo ALIF can expect improvement of lower back pain and disability in weeks to months following surgery.
As with any spinal surgery, the risks include: Bleeding from blood vessels Nerve injury causing leg pain, weakness and numbness, or urinary and defaecation problems Retrograde ejaculation/infertility in men Wound Infection Complication related to instruments Blood clot in the legs (deep vein thrombosis), and pulmonary embolism
What are the indications for the procedure?
Discogenic back pain (single or multiple level, including L5/S1) Low grade lumbar spondylolisthesis- bone slip Spinal instability Lumbar spondylosis Degenerative disc disease Failure of previous posterior lumbar fusion surgery with pseudoarthrosis Combined with posterior procedure to enhance bone fusion Correction of lumbar deformity
What is the road to recover and rehab like?
Length of stay in hospital is usually around 4-5 nights. Normally, the patient can resume fluid diet on the same day or the next day. Sometimes, abdominal distension might occur because of the bowel does not move (called ileus) for a short period of time. It normally resolves within 1-2 day(s). Walking and standing help to resolve ileus. Medications will be given to stimulate the bowel to move faster. In rare situation such as complex and prolonged surgery, the ileus can last for a week. The rehabilitation time is short. The incision heals by 2 weeks. Normally, the patient can resume office work by 2-3 weeks. Physiotherapy rehabilitation protocol will be given to guide the level of activities at different time. Sports can be resumed by 3-6 months depend on the speed of recovery.
How is the ALIF surgery better than other approaches to treat patients with discogenic back pain?
The ALIF approach is advantageous in that, unlike the PLIF and posterolateral gutter 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 bone in compression tends to fuse better. Lastly, a much larger implant can be inserted through an anterior approach, and this provides for better initial stability of the fusion construct
When can I resume my work and activities?
Patients may return to light work duties as early as 2-3 weeks after surgery, depending on when the surgical pain has subsided. Patients may return to moderate level work and light recreational sports as early as 3 months after surgery, if the surgical pain has subsided and the back strength has returned appropriately with physical therapy. Patients who have undergone a fusion at only one level may return to heavy lifting and sports activities when the surgical pain has subsided and the back strength has returned appropriately with physical therapy. Patients who have undergone fusion at two or more levels are generally recommended to avoid heavy lifting, laborious work, and impact sports.