Anterior Lumbar Interbody Fusion

PROCEDURES EXPLAINEDAnterior Lumbar Interbody Fusion

Anterior lumbar interbody fusion (ALIF) is a procedure performed from the anterior to fuse vertebrae into a single structure.

This technique is usually favored when several levels are fused, and several discs must be removed. Anterior lumbar interbody fusion is performed for painful spinal conditions such as spondylolisthesis and degenerative disc disease, among others.

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Patient Animation VideoAnterior Lumbar Fusion (ALIF)

What to Expect

  • You will have an IV placed in your arm or hand for the delivery of anesthetic to put you into a deep sleep and prevent pain during your surgery.
  • Your surgical team will usually consist of a vascular surgeon as well as an orthopedic or neurosurgeon.
  • Several techniques may be used, depending on the location of fusion, the reason for fusion, and in some instances, your general condition.
  • To gain access to the surgical site, the surgeon will make an incision relative to the site where the operation will take place.
  • The bone graft is then prepared, which may come from a bone bank, or from another location in your own body, typically the pelvis. In the latter case, the surgeon will make a small incision above the pelvis to retrieve a small portion of bone before then closing the incision. In some cases, synthetic material may be used in place of a graft which is formulated specially to promote bone growth and speed up the fusion process.
  • The diseased disc or discs are removed, and the area prepped for grafting.
  • Permanent fusion of the vertebrae is then initiated by placing the graft material between the vertebrae, and securing them with hardware such as plates, screws, and rods.
  • After the procedure is complete, the surgeon will restore all structures that were moved for the operation back to their normal locations.
  • The incision is then closed, and steri-strips may be placed to facilitate healing.
  • You will then be taken to a recovery area for close monitoring until you awaken. You will still have your IV, and may have a catheter to help facilitate urination while you recover. You may also have a sore throat from intubation. When you are fully alert and awake, you will then be returned to your hospital room.

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Common Risks and/or Frequently Asked Questions

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Bleeding

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Blood clots

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Nerve damage

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Return of symptoms

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Infection

Post Procedural Instructions

  • Activity Restriction
  • Pain Management
  • Incision Care
  • Call if
  • Desk jobs may be returned to in about 2 weeks, but others may require 4 weeks or more
  • Do not drive or operate heavy machinery while taking narcotics
  • Do not try to lift more than 10 pounds
  • Do not smoke
  • Walk as often as is comfortable on non-slippery surfaces
  • Be mindful of body motion practices, as discussed with your physical therapist
  • Post-procedural pain may last days to weeks as the inflammation subsides
  • Do NOT take NSAIDs in the first few months following surgery, as they can interfere with the bone healing process
  • Take your prescribed pain medication as recommended, and inform your care team if relief is inadequate. It is normal to feel some degree of pain during the recovery process, but it should not be excruciating.
  • Unless otherwise stated, your incisions are most likely sutured from the inside.
  • Dressings may be removed about 48 hours after surgery, and incisions should be washed with soap and water
  • Do NOT soak the incision site, baths, hot tubs, and pools should be avoided for 2-3 weeks until the wounds have fully healed
  • Sunblock with SPF 30 or greater may be used to protect healing skin from discoloration, as new skin will lack the sun protectant pigment melanin
  • Fever of 101.5 F or greater
  • Redness, swelling, warmth around the incision site
  • New neurological symptoms, such as weakness or loss of sensation that was not present before
  • Loss of bowel or bladder control that is new
  • Severe Pain
  • Difficulty swallowing or speaking
  • Severe Headaches
  • Calf Swelling, as this may be a sign of thrombosis
  • Chest pain, difficulty breathing, or cough
X-Ray
An effective and inexpensive option for quickly visualizing skeletal structures and isolating potential problem areas.
MRI
This is the treatment modality of choice for visualizing the soft tissues of the back such as ligaments and the intervertebral discs. Similar to CT, MRI imaging may also be enhanced with contrast.
CT Scan
In Computed Tomography, x-rays are taken rotationally and a computer generates a three-dimensional rendering from the two-dimensional slices. This can be enhanced with contrast, called a myelogram, to further visualize the spinal cord and nerves, as well as possible tumors.

Common
Recovery Timeline

Most patients are discharged from the hospital within the first few days of surgery.

The first week requires plenty of rest. Even so, you may be standing as early as the first day after surgery. By the end of the first week, tasks that do not require you to bend or lift should be manageable.

During the first few weeks, you will need help with daily chores such as cooking and cleaning from friends and family while you focus on letting your body heal from operation.

As you approach the month mark from the day of surgery, most patients are feeling more energetic. Adults start returning to work, while children and adolescents begin returning to school. Pain medications will usually be unnecessary by this point.

Despite feeling better, patients must still be careful to avoid overexertion.

At 6 weeks, your condition will be evaluated during a follow-up visit to evaluate if you can take on more strenuous activities.

By 12 weeks, x-rays will be taken to check on progress. If everything is as it should be, most patients are able to resume most normal activities, with the exception of a few potentially damaging activities requiring much spinal flexibility.

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