Anterior Lumbar Interbody Fusion (ALIF)

Abstract

Anterior lumbar interbody fusion is an important staple in the armamentarium of spine surgeons. The benefits of an anterior lumbar approach include broad exposure of the disc space allowing for thorough discectomy, effective endplate preparation, appropriate sizing and placement of an optimal interbody graft, and anterior fixation if necessary. ALIF also has the advantage of protecting the neural elements and surrounding dura and, as a result, is a particularly attractive option in patients with prior posterior surgery. With the placement of broad interbody grafts or devices under compressive loads, ALIF imparts high fusion rates and provides an extremely rigid construct when supplemented with posterior spinal fixation. Therefore, ALIF is a potentially useful complement to fusion constructs that are under large biomechanical stresses such as in deformity surgery or complex reconstructive procedures. While there are potentially significant risks associated with an anterior approach, a variety of techniques are available and may be adopted by appropriately trained spine surgeons or performed with the assistance of experienced vascular, urologic, or general surgeons. Ultimately, decision to perform ALIF as opposed to other spinal fusion techniques is dictated by the patient’s underlying pathology, anatomy, and associated medical comorbidities paired with the surgeon’s preference, education, experience, and overall expertise.