Anterior Lumbar Interbody Fusion (ALIF)

Anterior Lumbar Interbody Fusion (ALIF)

What is Anterior Lumbar Interbody Fusion or ALIF?

Anterior lumbar interbody fusion, also called ALIF, is a surgical procedure that is used to treat spinal problems like spinal instability, disc degeneration and deformities of the curves of the spine. In this operation, an anterior incision is made (from the front), and a disc is removed from the lumbar or lower portion of the spine. A bone graft is then inserted into the interbody space, which is the space created between two vertebrae when the disc was removed.

The goal of ALIF is to allow the vertebrae to fuse (grow together) into one solid section of bone. Fusion results in a rigid, stationary column of bone in the section of the spine that was causing pain or other problematic symptoms. The procedure is used in an effort to reduce back pain and other symptoms.

This brief guide will help you know more about:

- what your doctor hopes to accomplish

- what will happen during your operation

- what to expect after ALIF

Anatomy

What parts of the lower back and the spine are involved?

An ALIF involves the anterior longitudinal ligament, which attaches to the front of the spinal column. This is because the procedure is performed through the front or the abdomen. It also involves the vertebral bodies, which are the big bony sections of each vertebra, and the intervertebral discs, which are the cushions that lie between each pair of vertebrae.

What does my surgeon hope to accomplish?

ALIF is often used to relieve symptoms caused by lumbar disc disease. When vertebral discs wear out or degenerate, as a natural consequence of wear and tear due to aging or due to stress and strain, they begin to shrink and collapse. This decreases the space between the vertebrae.

When ALIF is successful, the fused vertebrae move as one unit rather than against each other. This helps reduce pain and prevents additional wear and tear changes on the section of the spine that was fused.

Preparation for ALIF

Preparing for ALIF surgery

You and your surgeon will decide together if ALIF surgery is right for you. It's important that you have a thorough understanding of the procedure and that any questions or concerns you have are answered by your physician.

To ensure you are in good physical condition before an ALIF surgery, your surgeon may recommend you undergo a complete physical examination. This will probably be completed by your general family practitioner.

In most cases, you will arrive at the hospital in the morning on the day of your ALIF surgery. You will probably be instructed not to eat or drink anything after midnight the night before ALIF surgery.

Surgical Procedure of ALIF

What happens during ALIF?

Most often, a general anesthesia is used to put patients to sleep during spinal surgery. During the operation, you may be assisted to breathe. A ventilator is a machine that helps you breathe and monitors your breathing.

During the procedure, you will be lying on your back, with a pad under your lower back. An incision will be made on one side of your abdomen. The soft tissues of the abdomen will be gently separated and held with retractors, and the blood vessels in front of the spine will also be moved aside so the surgeon can see the vertebrae.

A needle will be inserted into the disc and an X-ray will be taken to ensure the correct disc is chosen. The front of the disc will be opened and the vertebrae spread apart to allow the surgeon to see between them. The front half of the disc will then be removed. Sometimes a surgical microscope is used to help visualize pieces of the disc located near the back of the disc space.

A layer of bone is shaved off the flat surface of the two vertebrae causing them to bleed. This bleeding will stimulate healing. The space between the vertebrae is measured (height and depth).

The surgeon then removes a section of bone from the pelvis to use as a graft. It is measured to fit tightly where the disc was removed. A traction device is used to spread the vertebrae apart and the graft is set in place. Then the traction is released.

The graft is tested to make sure it is correctly placed and is firmly locked. Another X-ray may be obtained to ensure the fit and the location of the graft.

A tube may be placed in the wound to allow for drainage and the muscles and soft tissues are put back into place. The skin is then sutured together. You may be placed in a brace to support your spine while it heals.

Complications of ALIF

Possible complications

All major surgery comes with the risk of complications. Some of the complications associated with ALIF may include:

- nerve damage

- infection

- blood vessel damage

- problems with anesthesia

- ongoing pain

- nonunion

- blood clots

- problems with the hardware or the graft

- other complications

Problems with Anesthesia

Sometimes problems arise when other drugs the patient is taking causes a reaction to the anesthesia used during ALIF surgery.

Thrombophlebitis (Blood Clots)

Sometimes called deep vein thrombosis or DVT, blood clots can develop after any ALIF surgery. They occur when blood clots form in the large veins of the legs. One of the best ways to prevent them is to get up and moving around as soon as possible after ALIF surgery. Other preventative measures include:

- medications to keep blood clots from forming

- special elastic stockings to help keep the blood in the legs circulating.

Infection

Infection after an ALIF surgery is not a common complication, but it can be very serious. An infection can show up shortly after an ALIF or it can appear months or even years later.

Nerve Damage

When ALIF surgery is performed close to the spinal canal, the potential exists for injury to the spinal nerves or to the spinal cord itself. Injury can be caused by cutting or bumping nerve tissue during ALIF surgery.

Blood Vessel Damage

The surgeon has to move the abdominal aorta (the largest artery in the body) and the large veins close to it during the ALIF procedure. If these blood vessels are injured, internal bleeding may result.

Problems with the Graft or Hardware

In ALIF surgery, bones are grafted into the spine. Most often, the graft is harvested from the pelvis. Pain, weakness or infection are possible in the area where the graft was obtained.

Problems with hardware can also develop. Pins and/or screws can loosen and cause irritation of the soft tissues in nearby areas. Sometimes metal plates break. If this occurs, the surgeon may recommend another ALIF surgery to remove the hardware or to add additional hardware to create stability.

Ongoing Pain

ALIF is a complicated procedure. Not every patient experiences complete pain relief from the operation, but you can expect some relief from your pain. If your pain continues or is unbearable, ask your physician about treatment options to help with pain control.

After ALIF Surgery

After ALIF surgery, sometimes patients need to wear a rigid body brace. If the surgeon used metal hardware to hold the fusion in place, this may not be needed.

Recovery from ALIF

Recovering from ALIF can take some time. Outpatient physical therapy is recommended by many surgeons and usually begins no sooner than six weeks after the ALIF surgery. This is to make sure the graft is fusing before therapy starts. Therapy is typically ordered for at least eight weeks, but full recovery can take up to eight months. Rehabilitation usually progresses faster in patients who have had fusion with instrumentation

You might also like to review:
- Flexibility tests
- Magnetic Resonance Imaging (MRI)

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Questions & Answers
Q:
What is the best way to treat permanent back and neck pain and stiffness?
A:

Here are some tips:

Neck Pain Tips: Sleep with a cervical pillow

Orthopedic or cervical pillows are made with special contours to support the space beneath the neck and head. They are also more concave for the head and provide more support to the neck.

Neck Pain Tips: Sleep on your back

The best position to lie to sleep is on your back. If you sleep on your stomach or on your side, make sure your pillow is not too thick. It should raise your head no more than 4 to 6 inches. This will keep your neck and head from turning to either side.

Neck Pain Tips: Position your computer screen at eye level

While you are working at a computer, sit comfortably in your chair with your computer in front of you. Close your eyes and then open them. When you open your eyes, you should see the middle of the computer screen. If your gaze is not in the middle of the screen, adjust the height of the screen using items like books.

To keep your head from gradually drifting forward, take frequent breaks to stretch. Getting up to walk around at least once every half-hour is one of the best neck pain tips.

Neck Pain Tips: Use a telephone headset

Never hold a phone between your shoulder and your ear. Use a headset or other hands-free system to talk on the phone and avoid abusing your neck and spine.

Neck Pain Tips: Exercise your neck muscles

One of the best neck pain tips is using the chin tuck. You can do this often throughout the day. In addition to helping strengthen the muscles that hold the head in alignment over the shoulders, it also helps strengthen the scalene and sub-occipital muscles.

Read more tips here: Neck Pain Tips: Sleeping, Posture, Exercising, Hydration & Prevention

Read more
Temed Holdings
4 answers
Q:
What is the best treatment for neck pain and shoulder Pain?
A:

One of the best treatment for neck pain and shoulder pain is exercises:

Neck Pain Exercises: Neck Extension

  1. To begin this neck pain exercise, sit up straight in a chair with your feet flat on the floor.
  2. Looking straight ahead, tuck your chin slightly (starting position)
  3. Place the palm of your hand on the back of your neck, at the base of your head
  4. Apply slight forward pressure with your hand, while resisting the forward motion of your neck and head
  5. Hold for a count of 5 and return to the starting position and relax
  6. Repeat the neck pain exercises 5-10 times

Neck pain exercises: Side bend

  1. Sit up straight in a chair with your feet flat on the floor.
  2. Looking straight ahead, tuck your chin slightly (starting position)
  3. Place your left hand, palm down, on the left side of your head (around your ear)
  4. Slightly push your head to the right side with your hand, while resisting the sideways motion of your neck and head
  5. Hold for a count of 5 and return to the starting position and relax.
  6. Repeat 5-10 times
  7. Repeat the neck pain exercises with the other side.

Neck pain exercises: Neck flexion

  1. Sit up straight in a chair with your feet flat on the floor.
  2. Looking straight ahead, tuck your chin slightly (starting position)
  3. Place the tips of your fingers on your forehead
  4. Slightly push your head backward with your fingers, while resisting the backward motion of your neck and head
  5. Hold for a count of 5 and return to the starting position and relax.
  6. Repeat the neck pain exercises 5-10 times

More exercises here: Neck Pain Exercises

Read more
Temed Holdings
4 answers
Q:
How do I reduce the shoulder and neck pain?
A:

Here are some tips:

Neck Pain Tips: Sleep with a cervical pillow

Orthopedic or cervical pillows are made with special contours to support the space beneath the neck and head. They are also more concave for the head and provide more support to the neck.

Neck Pain Tips: Sleep on your back

The best position to lie to sleep is on your back. If you sleep on your stomach or on your side, make sure your pillow is not too thick. It should raise your head no more than 4 to 6 inches. This will keep your neck and head from turning to either side.

Neck Pain Tips: Position your computer screen at eye level

While you are working at a computer, sit comfortably in your chair with your computer in front of you. Close your eyes and then open them. When you open your eyes, you should see the middle of the computer screen. If your gaze is not in the middle of the screen, adjust the height of the screen using items like books.

To keep your head from gradually drifting forward, take frequent breaks to stretch. Getting up to walk around at least once every half-hour is one of the best neck pain tips.

Neck Pain Tips: Carry weight evenly

Many people make the mistake of carrying a heavy briefcase or their purse on their shoulder or on one side of their body. Doing this causes strain in the muscles and leads to pain.

Remove non-essentials from your briefcase or purse. Consider using a backpack to evenly distribute the weight across your shoulders. If you choose to carry a purse or backpack, keep your shoulders level while carrying it.

Neck Pain Tips: Maintain a proper posture

The most common posture contributing to neck pain is the “head-and-shoulders-forward” posture. In this position, the neck slopes forward, putting the head in front of the shoulders.

In this position, the head pulls the upper back forward also in a slumped position. This places a strain on the entire spinal column.

More tips here: Neck Pain Tips: Sleeping, Posture, Exercising, Hydration & Prevention

Read more
Temed Holdings
4 answers