Anterior Lumbar Interbody Fusion
Anterior Lumbar Interbody Fusion (ALIF) has evolved as a predominant surgical technique for mechanical axial back pain secondary to discogenic disc disease. The advantages of this technique is that it is a minimally invasive muscle sparing technique, which minimises the surgical footprint. Furthermore the restoration of disc height indirectly decompresses nerves and improves standing balance.
Finally the fusion rate with utilisation of this technique approached 100%.
ALIF is considered for back pain, when there is a discrete level involved as evidenced by typical changes on a MRI scan and/or movement on dynamic (flexion/extension) radiographs. It is also considered in revision spine surgery.
The diagnosis is made with history, physical examination and corroborated with focused X-ray and MRI examination.
Non -Operative Treatment
This involves rest, activity modification , pain-killers, physical therapy and occasionally corticosteroid and local anaesthetic injections.
The discspace can be approached through a number of corridors. Dr Nair utilises the reteroperitoneal (gains access to the discspace behind the bowel) approach and undertakes the operation in conjunction with a vascular surgeon. The diseased disc is then excised and an implant (interbody cage with bone substitute) is inserted under x-ray control. It is then secured in place. In certain instances, the device may require addition supplementation with posterior screws and this will be discussed in the pre-operative consultation.
Specific risks include: transient postoperative slowing of bowel movement (ileus), vascular injuries ( as the vessels lie immediately adjacent to the lower lumbar vertebrae) and in males retrograde ejaculation ( incidience of roughly 5% in the medical literature) . Other risks include subsidence of the implant, adjacent segment pathology and rarely non union.
Post Operative Course