Would an ALIF (fusion) be Helpful in Treating My Chronic Lower Back Pain?


While most cases of lower back pain will resolve with non-surgical treatments, some patients with chronic back and/or leg pain can benefit greatly from a surgery with a strange name: ALIF, or anterior lumbar interbody fusion, according to Dr. Praveen Kadimcherla with Atlantic Spine Center.

What is an Anterior Lumbar Spine Fusion

Anterior Lumbar Spine Fusion (ALIF) is a surgical procedure performed to treat certain conditions of the lumbar spine, which is the lower back region of the spine. This procedure is done to fuse one or more vertebral segments together to stabilize the spine and relieve back pain caused by conditions such as degenerative disc disease, spondylolisthesis, and spinal stenosis.

The procedure is typically done through a small incision made in the abdomen, allowing the surgeon to access the spine from the front. Once the surgeon has gained access to the spine, the damaged or diseased disc is removed, and a bone graft or synthetic material is placed in the space to encourage new bone growth. The bone graft is usually taken from the patient's own hip or from a donor. The surgeon may also use metal plates, screws, or rods to hold the vertebrae in place and aid in the fusion process. Most spinal surgeries are approached from the back, or posterior, side of the patient. An ALIF, however, accesses the spine using an anterior or front approach. The goal of the surgery is to fuse together painful vertebrae to heal into a single, solid bone. What spine conditions can prompt the need for an ALIF? According to Dr. Kadimcherla, the procedure can treat these conditions:

  • Instability and trauma
  • Degenerative disc disease
  • Disc tears
  • Failed back and neck surgery
  • Facet joint syndrome
  • Foraminal stenosis

But regardless of the exact condition it’s meant to correct, ALIF surgery aims to stop long-lasting pain that hasn’t responded to other therapies. “When motion is the source of the pain, spinal fusion surgeries such as ALIF can prove extremely helpful,” Dr. Kadimcherla explains. “If painful vertebrae cannot move, then they should not hurt.”

Benefits of ALIF

Compared to spine surgeries that approach the spine from the back, ALIF offers several key benefits, Dr. Kadimcherla says. They include:

  • Leaving back muscles and surrounding nerves undisturbed
  • Offering a larger surface area to operate from
  • Elevating the disc space more effectively, relieving painful pressure on surrounding nerves
  • Using a larger implant, leading to more stability in the affected area of the spine

How is the surgery performed? Your surgeon will make a small incision in the lower abdomen, carefully moving your abdominal muscles, organs and large blood vessels aside to access the spine. Then your damaged lumbar disc is removed, and a special implant called a cage is placed in the resulting space, restoring correct spacing between vertebrae. Within 2 to 3 hours, the surgery is complete and all structures in your abdomen are returned to their original spots.

“An anterior approach may be chosen for a variety of reasons, especially if you’d already undergone several previous spine surgeries approached from the back,” Dr. Kadimcherla explains. “The front approach also gives the surgeon more direct access to your vertebral discs, and the recovery can be quicker.”

Advantages of ALIF

ALIF has several advantages over other spinal fusion procedures. Because the surgeon accesses the spine through the abdomen, the procedure avoids the muscles of the back, which can lead to less postoperative pain and a shorter recovery time. Additionally, the anterior approach allows for greater access to the damaged disc, which can make it easier for the surgeon to remove the entire disc and ensure complete fusion.

Risks of ALIF

Like any surgical procedure, ALIF does carry risks. The most common risks associated with ALIF include infection, nerve damage, and blood clots. Additionally, the fusion may not be successful, and the patient may require additional surgery to correct the problem. In some cases, the bone graft or synthetic material used in ALIF may not fuse properly with the surrounding bone. This can lead to continued pain or instability in the spine, and may require additional surgery. Also, patients undergoing ALIF surgery will be placed under general anesthesia, which carries its own risks, including allergic reactions and complications with breathing and heart function.

Overall, ALIF is a well-established surgical procedure that can provide relief to patients suffering from certain conditions of the lumbar spine. If you are considering ALIF, it is important to talk to your doctor about the risks and benefits and to carefully weigh your options before making a decision.

Recovery tips

Full recovery from spinal fusion surgeries such as ALIF take time, mainly because the bone graft needs to grow and fill in spaces around the implant to form a “bone bridge” connecting the surrounding vertebrae. This fusion may also require screws or rods to be implanted during the surgery.

But short-term recovery is relatively quick, Dr. Kadimcherla notes. Most patients remain in the hospital for 1 to 3 days after surgery, where pain will be controlled and you’ll start to stand and walk around more and more.

To speed your recovery, Dr. Kadimcherla advises ALIF patients to perform any prescribed exercises diligently, as well as to walk about carefully. “It’s also important to avoid any twisting motions with your back as well as avoid bending or lifting heavy items,” he says.

If all goes well – as it usually does – ALIF patients can expect big benefits when their recovery is complete: A huge reduction in lower back pain, as well as in any disability they might have experienced before the surgery.

“Talk to your doctor about the possibility of ALIF surgery if your lower back pain has been insistent and long-lasting,” Dr. Kadimcherla says. “Your surgeon will be able to determine if you’re a good fit for this innovative procedure.”