Anterior Lumbar Interbody Fusion (ALIF)

If conservative treatments haven’t relieved your degenerative disc condition, anterior lumbar interbody fusion (ALIF) may be a surgical option. While most spinal surgeries use a posterior (back) approach, some patients benefit more from an anterior (frontal) approach.

At Hoag Orthopedic Institute, our board-certified, fellowship-trained surgeons specialize in ALIF procedures, carefully evaluating whether this approach is right for your condition. Their expertise ensures precise treatment to help restore mobility and improve quality of life.

What is Anterior Spinal Fusion Surgery?

ALIF is a minimally invasive spinal procedure used to treat certain degenerative spine conditions. Intervertebral discs, located between spinal bones, act as cushions for the spine. Each disc contains a gel-like center (nucleus pulposus) surrounded by a tough outer layer (annulus fibrosis). When a disc herniates or slips, the nucleus pushes through the outer layer, putting pressure on nearby nerves. This can cause considerable pain and mobility limitations.

Many patients recover from herniated or degenerated discs with conservative treatment. However, there are cases in which physical therapy and other noninvasive treatments do not provide the patient with pain relief. That is when minimally invasive ALIF surgery becomes a consideration.

Anterior spinal fusion surgery corrects issues with the spinal vertebrae by welding them so they heal together as solid bone. During the ALIF procedure, the intervertebral disc causing pain is removed through an incision just to the left of the navel.

The initial part of the operation involves removing the disc, followed by the insertion of a spacer made of plastic or metal into the disc space. Known as a cage, the spacer generally includes bone graft materials to facilitate fusion and speed healing.

Bone grafts are derived either from the patient, usually from the hip, or from a donor. Titanium grafts are another option for an anterior lumbar interbody fusion procedure. Screws or plates stabilize and secure the cage, and their placement may be done through the original incision.

During the operation, the surgeon must move abdominal organs, muscles and blood vessels. These are returned to their proper position when the procedure is finished and the incision is closed. Vascular surgeons often assist spinal surgeons during an ALIF surgery to manage blood vessels involving the legs.

When is ALIF Surgery Recommended?

A surgeon may decide an anterior approach provides safer or more effective access to the spine. This is especially beneficial for patients who have undergone multiple posterior spinal surgeries, as operating in the same area again may increase risks and complications. Other reasons for an ALIF surgery may include:

• Direct access to the impacted area
• Minimal nerve disruption
• Potential for faster recovery

Disc problems are not the only spinal issues suitable for ALIF surgery. Other spinal conditions that may benefit from this surgery include:

• Lumbar radiculopathy (nerve pain due to spinal compression)
• Multiple vertebral fractures
• Spinal curvature, such as scoliosis
• Spinal instability
• Spondylolisthesis (when one vertebra slips over another)

Who is Not a Candidate for ALIF Surgery?

ALIF surgery may not be best for patients with:

• Osteoporosis or brittle bones
• Obesity or severe osteoarthritis
• Diabetes or high blood pressure

The best ALIF surgery candidates are those whose discs collapsed in the lower lumbar region. For upper lumbar disc issues, other types of lumbar interbody fusion procedures may be recommended.

What to Expect During ALIF Procedure

ALIF surgery is performed while the patient is under general anesthesia and usually takes about two hours. During ALIF surgery, the procedure follows two key steps: First, the surgeon makes a small incision in the abdomen to access the spine. Next, the damaged disc is removed and replaced with a spacer (cage) filled with bone graft material to promote fusion. After surgery, you will be moved to the recovery room.

Anterior Lumbar Interbody Infusion Recovery and Rehabilitation

Most patients stay in the hospital for several days post-surgery, depending on the level of pain, mobility, overall health, and available support at home. Patients are encouraged to stand and walk on the first day after surgery, often with the help of a back brace.

Because back muscles and nerves were not disrupted during ALIF surgery, patients may recover more quickly than from a posterior surgery, but most patients cannot return to physically demanding work for at least six weeks. The surgeon will prescribe pain medication for patients undergoing physical therapy while recuperating.

ALIF Surgery Complications

As with any surgery, there is always the risk of complications. With ALIF surgery, these include:

• Infection
• Nerve damage
• Bladder and bowel problems
• Bleeding

Sometimes, the bone graft does not fuse, which may require additional surgery.

Why Choose Hoag Orthopedic Institute for ALIF?

There is a reason that Hoag Orthopedic Institute is one of the nation’s largest orthopedic care providers. Our track record in treating back pain and spine problems and the expertise of our doctors is second to none. Hoag Orthopedic Institute is nationally ranked as one of the top Orthopedic Hospitals by U.S. News & World Report in 2024-2025, and high performing in spinal fusion.

At Hoag Orthopedic Institute, we offer personalized treatment plans for every patient. Schedule an appointment with a spinal specialist today to determine whether ALIF surgery is right for you.