Modern Applications of ALIF Surgery
While the ALIF is still a widely available spine fusion technique, this type of procedure is often combined with a posterior approach (anterior/posterior fusions) because of the need to provide more rigid fixation than an anterior approach alone provides.
- In cases where there is not a lot of instability, an ALIF alone can be sufficient. Generally, this is true in cases of one level degenerative disc disease where there is a lot of disc space collapse.
For patients who have a “tall” disc, or for those with instability (e.g. isthmic spondylolisthesis), an anterior approach to spinal fusion may not provide adequate stability. In these clinical situations, the anterior lumbar interbody fusion may be supplemented with a posterior (from the back) instrumentation and fusion to provide additional support to the fused level of the spine. For more information, see Spinal Fusion Surgery for Isthmic Spondylolisthesis.
Advantages of ALIF Surgery
The anterior lumbar interbody fusion (ALIF) is similar to the posterior lumbar interbody fusion (PLIF), except that in the ALIF, the disc space is fused by approaching the spine through the abdomen instead of through the lower back.
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.