Indications for anterior lumbar interbody fusion

Abstract

Anterior lumbar interbody fusion (ALIF) has become a widely recognized surgical technique for degenerative pathology of the lumbar spine. Spinal fusion has evolved dramatically ever since the first successful internal fixation by Hadra in 1891 who used a posterior approach to wire adjacent cervical vertebrae in the treatment of fracture-dislocation. Advancements were made to reduce morbidity including bone grafting substitutes, metallic hardware instrumentation and improved surgical technique. The controversy regarding which surgical approach is best for treating various pathologies of the lumbar spine still exists. Despite being an established treatment modality, current indications of ALIF are yet to be clearly defined in the literature. This article discusses the current literature on indications on ALIF surgery.

Keywords: Anterior lumbar interbody fusion; Indications.

Figure 1

(A) Distribution of spinal loads on the anterior and posterior weight‐bearing columns in a normal lumbar spine. (B) Shifting of spinal loads to the posterior column after degenerative pathology to the lumbar spine.

Figure 2

(A) ALIF interbody device with integral fixation. (B) ALIF implant with anterior plate fixation. (C) ALIF implant with posterior instrumentation.

Figure 3

(A) T₂ MRI of a L₅S₁ spondylolisthesis. (B) T₁ MRI of a L₅S₁ spondylolisthesis. (C) X‐ray after ALIF surgery with internal fixation and interbody device.

Figure 4

(A) MRI showing degenerative disc disease with foraminal stenosis at the L _4–5 and L₅S₁ levels prior to ALIF surgery. (B) Post‐operative X‐ray with anterior interbody fusion at L _4–5 and L₅S₁. (C) Onlay of MRI‐X‐ray showing the interbody device.

Figure 5

Degenerative lumbar scoliosis managed with ALIF and percutaneous pedicle screw fixation.

Figure 6

Lateral X‐ray lumbar spine demonstrating an L _3,4 ALIF, performed 18 months following posterior fusion with non‐union of the posterior elements (see arrow).