Thanks to the increase in surgical techniques, surgeons are nowadays capable of performing spinal surgery from the front for certain spinal conditions.
This has the advantage that the posterior dorsal muscles do not have to be harmed and nerve structures do not have to be manipulated (and so, they cannot be damaged during spinal surgery).
ALIF surgery consists of fixing the lower back using an anterior approach. The orthopaedic spinal surgeon will access the spine through an incision in the abdomen. Thanks to a particular surgical technique they will not have to work through the abdominal cavity, but they can go behind the intestines.
This approach has significant advantages with regard to postoperative rehabilitation. As with any surgery, there are also disadvantages. Since surgery is performed close to major blood vessels, there is always a risk of them becoming damaged. Sometimes a larger incision will have to be made to repair a possible blood vessel injury. We always ask a vascular surgeon for assistance in that case.
In men there is also a risk of retrograde ejaculation (<1%) when semen enters into the bladder instead of going out.
This type of spinal surgery is performed under general anaesthesia. First, a bone graft will be taken out of the anterior pelvic rim. Unlike a bone graft taken from the posterior pelvic rim, this will cause few problems in the long run. After this, the spine will be accessed through a separate incision. Picture 1: Thanks to this approach the surgeon has a perfect view of the intervertebral disc. Picture 2: Incision pelvic rim and abdomen.
As soon as the surgeon has a perfect view of the spine, the degenerate intervertebral disc that causes all the problems, will be removed entirely. It will be replaced with a carbon cage filled with bone from the patient’s own body. During spinal surgery the surgeon will usually place an additional fixation plate to create more strength and to increase the chances of growth. Pictures 3 and 4: the cage and the plate put in place.
After this surgerical procedure on the spine, the patient will need to wear a corset for roughly six weeks. The patient is advised against smoking, since smoking hinders the bone growth.
If surgery is performed at the lowest level (L5-S1), you must not sit for a long time on end in the initial phase. Injections against phlebitis are recommended during the first three weeks after surgery
Of course, as with any spinal surgery, we cannot guarantee a perfect result. There are also risks involved in this type of surgery. The patient needs to decide if the advantages outweigh the disadvantages.
ALIF surgery is recommended for every patient if there is no contraindication for anterior surgery and if placing a disc prosthesis is not desirable. L5-S1 is the best level to perform ALIF surgery at, since we dispose of adequate fixation systems for this.
After surgery the pain in the leg may have disappeared immediately, but this is not nearly always so. Pain medication will be administered during and after surgery. You will have to stay in bed for one or two days. As soon as you are capable of walking down the hall and going up and down stairs after surgery, you are ready to go home. This is usually four to six days after surgery. During your hospital stay you will be given a daily injection against phlebitis. This will not be necessary anymore after your discharge form hospital, unless your doctor tells you otherwise, for medical reasons. You will also have to wear compression stockings for three weeks. You will be measured for a corset. You will have to wear this for six weeks.
Naturally, the speed of your recovery will depend on the seriousness and the duration of your condition. If you had long-standing pains or long-standing loss of function, recovery will usually be much slower. It can take many months for nerves to heal, sometimes even 1 to 2 year. The radiation symptoms in the legs (loss of strength or sensation) will disappear either quickly or slowly, according to the seriousness of the nerve damage. They may never disappear completely.
In any case, your activities will need to be limited during the first three months. During the first three months the patient must not bend forward and pick up objects below the waist. This entails that most daily activities will be impossible. After this period you can slowly increase the level of your activities. Normal activities can be resumed after six months. It is only normal that you will sometimes need to take pain killers in the first weeks or months.
After a fusion in the lower back chances are fairly high that you will still be slightly troubled by your back (easily tired, difficulty with extreme movements, or with lifting objects). Your back will also have to get used to a different situation. Some patients become totally free of symptoms, but others keep having some back pain that is easily bearable.
In any case, your will have to protect your back all your life against quickly developing wear-and-tear, by taking good care of the muscles of the torso. It is of the utmost importance that even after spinal surgery any kind of work that could overload the back, , will have to be avoided, even when surgery was a complete success.