- Leg pain, numbness, and/or weakness
- Back pain, especially with movement
- Bowel or bladder incontinence
Typical X-Ray Findings
- Spondylolisthesis, or slippage of one vertebral body upon another (MRI, CT myelogram).
- Disc and endplate changes suggesting excess “wear and tear” (MRI, CT myelogram).
- Excess movement of one vertebral body upon another when bending forward or backward (Flexion and extension x-rays)
Average Procedure Time
- 1.5 hours
Average Recovery Time
- Home once passing gas (1-3 days)
- Off work 6-8 weeks, depending on duties
- No bending, twisting, lifting, or strenuous exercises (8 weeks)
- No driving while on narcotics
Since the abdominal contents lie immediately in front of the lumbar spine, ALIFs are generally done in conjunction with a general surgeon familiar with spinal fusion operations.
During the operation, the general surgeon makes an abdominal incision and exposes the lumbar spine by retracting critical abdominal structures out of the way. Next, the disc is removed almost in its entirety. A large interbody cage is then filled with bone graft and inserted into the disc space. Some surgeons use screws and/or plates to secure the cage in its place between the vertebral bodies. In cases of severe instability, the ALIF is followed by a posterolateral lumbar fusion and minimally invasive instrumentation with screws and rods placed from behind. This type of “front-back” operation is often called a “360 degree fusion”, or simply a “360”.
The principal advantage of an ALIF is that it allows for removal of almost all of the intervertebral disk and placement of a large cage that can hold more bone graft, both of which increase the chances of successful fusion. In addition, severly dislocated vertebral bodies are most easily brought back into alignment through an anterior approach, so many surgeons prefer ALIFs for patients who have large spondylolistheses, or slippages.
The principal disadvantage of an ALIF is, of course, that it involves an abdominal incision and retraction of abdominal structures.