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Anterior Lumbar Interbody Fusion (ALIF)

Over the years, Dr. Greenwald has helped many patients alleviate lower back pain by performing Anterior Lumbar Interbody Fusion surgery, also called “ALIF.” This procedure is often a last resort solution for patients who live with chronic, debilitating lower back pain, as a result of degenerative disc disease or instability due to intervertebral disk damage, changes in the lumbar spine due to arthritis, or post operative instability. Through a meticulous surgical approach, Dr. Greenwald can perform the Anterior Lumbar Interbody Fusion in a way that decompresses the affected nerves and achieves optimal spacing between the affected vertebrae. Further, he takes great care to work with every patient after ALIF surgery, to ensure the best possible outcome. If diagnostic imaging tests have shown that your issue is best addressed by Anterior Lumbar Interbody Fusion surgery, or if you would like a second opinion, please contact our office at (650) 968-4747 to schedule a consultation with Dr. Greenwald.

What is Anterior Lumbar Interbody Fusion?

The spinal column plays a vital, and often misunderstood, role in our daily lives. In many ways, the spine is an evolutionary marvel that is flexible enough to increase our range of vision and motion, yet has sufficient rigidity to support our weight and allows us to stand, walk, and run upright.

Further, the spinal column plays a vital role in supporting and protecting our central nervous system, by providing a channel for the spinal nerve, with the bony vertebrae acting as a layer of protection from accidental injury.

The spine consists of individual bones (vertebrae), which are connected together by ligaments and muscles. The vertebrae are separated by flexible discs with a gel-like center, to help cushion impact within the spinal column and provide us with added flexibility. Additionally, the vertebrae have small openings that form the spinal canal, to keep the spinal cord protected and for the nerves to exit.

Within the spinal column is a distinct section called the lumbar spine. This section is located roughly between the ribs and the pelvis, and consists of five vertebrae that bear most of the body’s weight, allow us to bend forward, and to rotate from side to side as a means of extending our ability to see and reach things in three-dimensional space.

Unfortunately, the vertebrae and intervertebral discs can change in shape over time, causing pinching of the spinal nerve and the nerves that radiate out of the spinal column. Some of the factors that can cause these issues include:

  • Physical injury due to accidents
  • Work related injury
  • Lifestyle factors (such as posture, certain hobbies and sports)
  • Changes in intervertebral disc shape and position due to age-related factors
  • Excess bone growth on the vertebrae caused by arthritis, causing the nerve exit points from the spine (also called the foramina) to become narrowed, thus pinching the nerves
  • Changes due to Laminectomy
  • Congenital abnormalities, such as Spondylolisthesis, causing instability and slippage

This can lead to persistent pain in the back, cause weakness in the legs, and make it difficult to move. Some patients may feel as if one or both of their legs are paralyzed, and may need a walker and other assistance just to walk around.

Although in some cases the damage can be healed with therapy or may resolve on its own, some patients may require Anterior Lumbar Interbody Fusion to decompress the surrounding nerves and limit the movement of unstable affected vertebrae.

When performed by an experienced surgeon with extensive experience (with proper decompression of the surrounding nerves and proper spacing of the bone graft), the Anterior Lumbar Interbody Fusion can yield a dramatic improvement in quality of life.

How is Anterior Lumbar Interbody Fusion Performed?

The goal of Anterior Lumbar Interbody Fusion is to fuse two or three of the affected vertebrae in a fixed position that alleviates pressure on the surrounding nerves and prevents future movement between the vertebrae.

Although this is a very intricate procedure, here are just some of the major steps Dr. Greenwald takes during the surgery:

  • Incision:  In order to reach the affected vertebrae and disc(s), the ALIF incision is made in the lower abdomen. Although it may at first seem counterintuitive to approach the spine from the front of the body (the “anterior” in Anterior Lumbar Interbody Fusion), this actually makes it easier for the surgeon to reach the area without having to manipulate the spinal cord or the surrounding nerves in the back of the spine. After the incision is made, the abdominal organs and tissues are carefully moved out of the way, to allow Dr. Greenwald unobstructed access to the damaged vertebrae and disc(s).
  • Removing the Disc:  To perform the fusion process, the intervertebral disc must first be removed. Dr. Greenwald performs this step very carefully, so that the surrounding tissues and the surrounding nerves are not negatively impacted in the process.
  • Nerve Decompression:  In addition to removing the disc, it is vital to replace it with a bone graft, to establish the normal disc anatomy and thus decompress the nerves.
  • Bone Graft:  The next step in the process involves properly implanting the bone graft between the vertebrae. During this step, Dr. Greenwald is meticulous about achieving proper spacing between the affected vertebrae. The graft must be properly sized, to reestablish normal anatomy. This graft size is essential to opening the canal for the nerves.
  • Plate for Stability:  To ensure proper healing and fusion, Dr. Greenwald may attach a special plate to the vertebrae, using small screws. This helps keep the vertebrae and the bone graft in place, and ensures that the bones fuse together in proper position.

Over time, the vertebrae will become fused into one solid bone segment. Since the vertebrae will now be in a fixed position in relation to each other, the likelihood of nerve pinching in the area due to movement is significantly reduced.

Recovery from Anterior Lumbar Interbody Fusion

Anterior Lumbar Interbody Fusion recovery takes several months, during which time bone tissue grows in the area and the vertebrae become fused. Because the lumbar spine plays such an integral role in bearing our body weight and providing a center of gravity, it is crucial to follow all after care instructions that will be provided by Dr. Greenwald.

For example, it is important to keep the back straight and avoid bending down or turning the torso during the first few weeks after surgery. This is because the vertebrae will not have fused yet, and will want to follow the natural motions of the body.

Patients are also advised to take time off work for the first several weeks, until cleared by Dr. Greenwald to return to regular duties.

Carefully following all instructions after Anterior Lumbar Interbody Fusion will ensure proper healing and will provide for a better long term result.

Benefits of Anterior Lumbar Interbody Fusion

Anterior Lumbar Interbody Fusion is a long term solution for relieving pressure on the surrounding nerves, relieving the associated back pain and/or leg numbness, and significantly improving the patient’s quality of life. Although it can take approximately one year for the bones to become extensively fused, most patients are able to return to a lighter version of themselves several months after surgery.

The full effects of the surgery will also depend on the patient’s unique situation, such as the presence of degenerative diseases like arthritis, as well as previous damage to other parts of the spine.

Side Effects of Anterior Lumbar Interbody Fusion

Fusing two or three lumbar spine vertebrae together will inevitably lead to some loss in the patient’s range of motion in terms of turning the torso. However, the reduction in pain and improvement in quality of life significantly outweigh any such effects.

Dr. Greenwald takes this aspect very seriously and works very hard to help every patient achieve meaningful improvement, so that they can lead a healthy, fulfilling life after Anterior Lumbar Interbody Fusion surgery.

Your Anterior Lumbar Interbody Fusion Consultation

If your primary care physician believes that you would benefit from Anterior Lumbar Interbody Fusion, or if you would like a second opinion, please contact our office to schedule a consultation. Dr. Greenwald will take the time to speak with you about the problem, review your imaging results, and may order additional tests to ensure that ALIF surgery is the best option in your situation. To schedule your Anterior Lumbar Interbody Fusion consultation, please call our office at (650) 968-4747, or send us a message through the Contact Form.

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