22 Apr Spinal Stabilization: What is Mini-Open Anterior Lumbar Interbody Fusion (ALIF)
Spinal fusion is a surgery that is used to fuse two or more vertebrae (bones that make up the spine) in the spine. The spine is made up of 33 vertebrae, 7 cervical spine in the neck region, 12 thoracic spine in the mid-back, 5 lumbar spine in the lower back, 5 sacral spine and the last 4 called the coccyx (tail bone). Spinal fusion aims to relieve pain in the patient’s back as it fuses the vertebrae together, preventing too much movement and therefore aiming to provide pain relief.
Although spinal fusion is traditionally done as an open surgery, today, many spine surgeons use minimally invasive keyhole techniques to perform spinal fusion. Minimally invasive spinal surgery has many advantages such as smaller incisions, that lead to smaller scars, less blood loss, less pain after surgery. This also leads to shorter hospital duration and faster recovery allowing patients earlier return to activities and routines.
There are many minimally invasive keyhole spinal surgical techniques for spinal fusion. This article concentrates on a technique called the mini-open anterior lumbar interbody fusion (ALIF). Since the term anterior means front, this technique takes the approach from the front compared to most procedures where the patient is lying prone (on their chest and belly) during the surgery. This technique has the advantages of not having to cut through or disturbing any of the structures in the back.
The ALIF technique also allows the easier insertion of a larger implant from the front of the patient’s body if necessary. Since the surgeon has the access to the front of the patient’s spine, the surgeon also has direct access to the entire disc. With more surface area that is available due to the direct access, it also allows for better fusion. During the ALIF procedure, the nerve structures are also not manipulated as it takes the anterior approach.
This procedure is mainly and often used to fuse the 5th lumbar spine and the 1st sacral spine. It can also be used to fuse other levels of the spine. Spinal fusion is more common in the lower levels of the spine as it supports most of the body weight and is one of the most common source of pain in patients. The mini-open ALIF aims to relieve the pressure on the compressed spinal cords or pinched nerves and also to stabilize the spine.
The mini-open ALIF procedure is most commonly used in patients who have degenerative disc disease (due to wear and tear, especially older patients), arthritis of the spine and spinal stenosis (that can be due to narrowing of the spinal canal where the nerve exits the spine, bulging or herniated discs). This procedure takes approximately 1-2 hours to perform and although has many advantages as a minimally invasive keyhole spinal procedure, it still has risks associated with surgery such as injury to the surrounding structures such as nerves and muscles, infections, or the need of an additional surgery if the surgery is not successful.
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- Highsmith JM. Mini-open ALIF: Using fusion to help stabilize your spine. Spine Universe. https://www.spineuniverse.com/treatments/surgery/minimally-invasive/mini-open-alif. Accessed 3/8/2017.
- Skovrlj B, Gilligan J, Cutler HS, Qureshi SA. Minimally invasive procedures on the lumbar spine. World J Clin Cases. 2015; 3(1):1-9.