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What Is an Anterior Lumbar Interbody Fusion?

According to the National Institute of Health, a quarter of U.S. adults experienced low back pain during the past three months. These problems can make daily activities difficult or even impossible and diminish quality of life. An advanced procedure called anterior lumbar interbody fusion is bringing about remarkable relief for low back pain. Subach Spinal Solutions in Arlington, VA offers best-in-class expertise with this effective procedure.

What Is Anterior Lumbar Interbody Fusion?

Anterior lumbar interbody fusion (ALIF) is a specialized surgical procedure where sections of the spine are fused together to provide relief from back pain. The spinal column is a highly complex part of our anatomy. In addition to its 33 vertebra bones, it also incorporates a multitude of associated muscles, ligaments, shock absorbers (called disks) and joints. Abnormalities or wear to any of these spinal components can cause debilitating pain.

Disks that have become worn, misshapen or partially torn are a key cause of lower back pain. The ALIF procedure uses a bone graft to fuse together two or more bones, and the procedure often eliminates a damaged disk. In the ALIF procedure, the surgeon will place a bone graft to rebuild the empty space where a problematic disk has been removed. As the patient heals from the surgery, the bones ultimately fuse together into a single contiguous section.

What Conditions Warrant This Procedure?

Chronic lower back pains occur for a wide variety of reasons. In many cases aging is the culprit; many parts of our body simply wear down as we get older. This is especially true around the spine, which carries the heavy duties of weight bearing, balance retention and upper body strength, among other tasks, throughout our lives.

Age and wear on the spine and its components vary by the individual and their personal histories. An old injury from high school or what seemed to be a minor car accident in childhood can come back to haunt the patient many decades later. Ironically, people who lead athletic lifestyles can be prime candidates for back pain. In particular, running and jumping place unnatural strains on spinal components. Repeated thousands of times over the course of years, these movements can accelerate decay and damage.

Anterior lumbar interbody fusion is often sought as a solution to the following back problems:

Degenerative Disk Disease

This age-related condition happens when one or more of the disks between the spinal vertebra deteriorates, bulges, tears or flattens down. Spinal disks work like shock absorbers between the vertebrae. As we age, these disks can literally dry out, becoming thinner and offering less protection. In some cases, the stress of everyday movements or sports activities can cause tears in the outer wall of the disk or cause it to move out of position. This “slipped” or herniated disk can be excruciatingly painful and in most cases will need medical treatment.


Neoplasia is an abnormal growth of cells in the body which can be benign or malignant. The growth itself is called a neoplasm. A malignant neoplasm, known to most people as a tumor, spreads quickly to other tissues and is a significant cause for concern beyond back pain. Benign neoplasms don’t spread throughout the body, but when they are located near the spine, they can touch sensitive nerve endings and cause significant discomfort.


Best known to laypersons as a pinched nerve, this condition can cause significant problems when located in the spinal column. One of the most common causes for this condition is a narrowing of the space where the initial segment of nerves (called the nerve root) exits the spine. The result is most often pain, but symptoms can also include numbness, weakness and tingling sensations.

Why Anterior and Not Posterior?

The word “anterior” means something that is coming towards the front of the body. This is opposed to “posterior,” which indicates something coming towards the back of the body. As its name implies, an anterior lumbar interbody infusion is performed by surgically entering the patient from the front – in this case, through the abdomen.

Since the spine is located in the rear of our body, this technique may seem counterintuitive. However, there are numerous medical benefits to using the anterior approach. When the surgeon uses the ALIF technique, the delicate muscles and nerves in the back remain undisturbed. This is particularly important for patients who have already had other back surgeries.

Other advantages to going in through the front (anterior) to correct back issues include ease of positioning for the key vertebra, the opportunity to use larger implants, and the advantage of maintaining the natural anatomical curve in the spine when approached from the front. Placing the bone graft in the front of the spine provides natural compression, and bones that are compressed tend to fuse more effectively.

A Snapshot of the Surgery

During anterior lumbar interbody fusion, the spine surgeon and a vascular surgeon work together as a team. After the incision is made in the abdomen, the vascular surgeon, a specialist in blood circulation, clears a pathway to the spine. Blood vessels are moved out of the way for the spinal surgeon to work; particularly key vessels that circulate to the legs.

When this task is completed and circulation is under monitored control, the spine surgeon removes the damaged disc and fills the space between the spinal bones with a bone graft. The graft acts as a “spacer” that preserves the correct height between the bones. It works with the curvature of the patient’s spine and provides space that relieves the pinched nerves of radiculopathy.

As the body recovers from the surgery and begins to heal, new bone grows around the graft. After a recovery period of three to six months, the graft will have fused the vertebrae into a single, solid piece of bone. While some patients report a change in their spinal flexibility post-surgery, many others don’t notice any significant change other than relief from their back pain.

What Happens Post Operation?

Most ALIF surgeries take several hours to perform in a hospital setting. The patient should expect to stay in the hospital for several days. The “typical” recovery time varies widely based on many individualized factors, including the amount of surgery needed, the patient’s other medical conditions, and perhaps most importantly, how closely the patient follows the doctor’s post-operative care instructions.

Light movement (sitting in a chair, etc.) will be encouraged by the surgeon as soon as the patient is awake and ready for it. Most patients will be able to return home in two to four days after the surgery. It is recommended that the patient get enough rest once back at home, and it’s best to have some help around so that any heavy lifting or strenuous activity can be avoided. Some patients go home with a brace that limits motion for a set period of time during recovery.

How Long Is the Recovery?

If the patient is not dependent on pain-reducing medications such as opioids, driving may be resumed two to three weeks after the surgery. According to most reported outcome data, it takes four to six weeks for the patient to return to an office or sedentary job. However, it can take three to six months to return to strenuous activities that are more physical, such as construction or weightlifting (whether for work or for sport).

The newly fused bone will continue to solidify for a year to a year and a half after the surgery. Many people with a single-level fusion (a fusion where only one “splice” in the spine has been necessary) are able to return to even strenuous activities by about six months after surgery.

How Can I Prepare for a Successful Procedure?

While the spinal specialist will have the most important advice on preparation leading up to the surgery, the clinical literature is unanimous in prohibiting tobacco use. This encompasses nicotine in all forms: cigarettes, cigars, chewing and vaping. Nicotine is known to retard bone growth, which is the essential point of this procedure.

The risks from nicotine to this procedure alter the odds of a successful outcome in a serious way. A clinical study showed that fusion fails in 40% of smokers compared with just 8% of non-smokers. Smoking decreases blood circulation, which results in slower healing and increases the risk of infection. If you are a smoker and considering this surgery, talk with your doctor about ways to help you quit. Patients may also be advised to not drink alcohol one week before and two weeks after surgery to avoid bleeding problems.

What Can I Expect During Recovery?

Your surgeon will keep close watch on you while in the hospital and will schedule a follow-up appointment that typically takes place two weeks after surgery. The recovery time to “normal” daily activities, without undue concern for the fragile spinal work, may last from six to 12 weeks.

In the follow-up period, the surgeon may image the work with X-rays to verify that the intended fusion is progressing in the way intended. Based on the progress seen in this follow-up visit, the surgeon will decide when you will be ready to return to work.

The process of spinal fusion takes time. Two bones are literally growing together into one piece! For the first two or three months, patients are advised to limit bending, lifting and twisting to a light level that’s commensurate with recuperation from back surgery. This not only safeguards the surgeon’s delicate work, but it’s also key to reducing potential pain and avoiding a recurrence of the problem.

How Can I Help My Recovery?

In addition to following doctor’s orders, halting nicotine intake and taking it easy on the bending, lifting and twisting, patients who have repaired their back through anterior lumbar interbody fusion can help themselves through their recovery and beyond. Forming good habits and creating helpful environments can ensure the success of the procedure keep back issues from returning.

Use Correct Lifting Techniques

We’ve heard it all our lives: “lift with your legs!” Lifting too much weight using only the back and arms is a recipe for back pain and a non-starter for the post-op patient.

Maintain a Healthy Body Mass

Obesity affects many systems throughout the body, but backs and legs are especially vulnerable. It is important to maintain a healthy body mass index through diet and exercise.

Use Healthy Body Mechanics

The back is a centerpiece of both active movement and sedentary non-movement in our daily lives. Observing good posture, sitting in an ergonomic chair and sleeping on an appropriately supportive mattress will all have significant effects on recovery and future back health.

How Can I Get Started?

If you suffer from lower back pain, ALIF surgery can dramatically improve your quality of life. Contact Subach Spinal Solutions, in Arlington, VA to schedule an initial consultation.

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