Anterior Lumbar Fusion (ALIF)
Sharing a similarity to the posterior lumbar fusion surgery, an anterior lumbar fusion, or ALIF, works to fuse the spine by approaching through the patient’s abdomen. Using this approach, the muscles and abdominal organs are easily moved aside without damaging them. Dr. Peelle may choose to use an anterior approach for the benefits it provides over a posterior approach, as the nerves and muscles of the back remain undisturbed in this approach, aiding in recovery time and avoiding further damage to the spine.
Additionally, fusions are often more successful when the bone is under compression, and placing the bone grafts on the anterior of the spine places produces this condition. Finally, the anterior approach permits the use of a larger implant, providing greater initial stability of the fusion structure. Most patients return home three or four days after the surgery, provided that their pain is under control with the use of pills, the incision is showing no signs of drainage, and bowel and bladder function is normal.
1. Where does the bone for the anterior lumbar fusion come from?
Where the bone for your fusion comes from varies by the surgery, your personal health and condition, and the decision of Dr. Peelle. In many cases, the bone graft will come from the top ridge of your hip, known as the iliac crest, and is generally the preferred source as it introduces living bone into the surgery site. Alternately bone grafts from cadavers may be used, though these will be stuffed with shards of living bone from your surgery site to facilitate healing. Finally, there are alternatives that are a combination of synthetic and living bone shards that are sometimes used. Speak to Dr. Peelle to discover which is relevant to your case.
2. What are the possible complications with an anterior lumbar fusion?
All surgeries, however minor, have the possibility of minor complications. Anterior lumbar fusions are generally safe procedures, but when complications occur, the most common are nerve pain, blood clotting, infection, dural tears (a tear in the protective layer, the dura, that holds in your spinal fluid and protects the cord). There are a couple complications unique to ALIF procedures. The first is a result of the surgery sites proximity to the large blood vessels that lead to the legs, any damage to these can result in large amounts of blood loss. For males, there is a unique complication known as retrograde ejaculation, which can lead to reproductive issues. Discuss this with Dr. Peelle if you’re concerned.
3. What will my recovery from anterior lumbar fusion be like?
In the weeks following your return home, you will be encouraged to maintain an active walking schedule, as much as an hour or two a day to aid in the strengthening of your lower back. If provided with a brace you must wear it at all times, except during sleep or bathing. In most cases, it will take three or four months for the fusion to heal, and your return to work will be under Dr. Peelle’s advisement.