lumbar interbody fusion (ALIF) is performed to fuse two vertebral
bodies together. It is often done to improve low back
pain. Titanium alloy cages are generally used, and may
be packed with the patient's own bone, or bone bank bone may
be used. The patient is taken to the operating room,
and the surgeon may first harvest bone from the hip from the
back or the front. Next, the approach is made for the
lumbar interbody fusion. This is done from the front,
through the abdomen. The approach exposes the lumbar
spine, and the aorta and vena cava or iliac veins and femoral
arteries are mobilized to provide access to the spine.
There is a plexus of nerves in front of the spine, which control
sexual function in the male. Once the spine is exposed,
the surgeon will implant the cages, packed with bone, into
the disc space, with the edges of the cage cutting into the
bone of the vertebral bodies above and below. C- arm
fluoroscopy (real time x-ray) is used to help assist the surgeon
in placement of the cages. The surgeon may clean out
the disc space, prior to placing the cages. After this
is completed, closure will be performed. The patient
is then taken to the recovery room. The surgeon may
elect to leave the ALIF as a stand alone procedure, or may
supplement it with a posterior fusion (from the back).
lumbar interbody fusion (ALIF) is a frequently performed
procedure. Risks of the procedure can be broken
down into two categories, 1) those related to the operative
site, and 2) those related to the risks of anesthesia.
related to the operative site:
Exposure: The patient is placed in a supine position
(on their back). In this position, despite
great care, there can be pressure sores to the skin and
pressure injuries to nerves. Several large blood vessels
are exposed and these may be injured. If so, there
may be significant blood loss. In men, injury
to nerves located near the front of the spine may result
in retrograde ejaculation. If this is a concern, and
the patient desires to still have children, he may choose
to first donate to a sperm bank. In addition, there
is risk of damage to the ureters, which pass urine from
the kidneys to the bladder. The patient may experience
pain in the hip where the bone graft was taken from.
Cord/Nerve Root injuries: If there is any injury to the
spinal cord (in the upper lumbar area) or nerve roots,
the consequences may involve loss of sensation, increased
burning sensation, paralysis, weakness, loss of bowel, bladder,
sexual function. There is a risk of disc material
being pushed in the spinal canal, requiring surgery from
the back, to decompress the nerves in the spine. It
is possible that due to the anatomy, only one cage (instead
of the typical two) may be placed. If there is significant
scarring (possibly from previous abdominal surgery), or
if the major blood vessels cannot be sufficiently moved,
the surgeon may not be able to place the cages, and the
intended levels may be left unfused. There is also
the possibility that the fusion may not heal and the two
vertebral bodies surrounding the cage may remain unfused.
Surgery on the back of the spine may be necessary, either
to decompress a nerve, or to fuse with bone graft and instrumentation.
There is a possibility that the cage may slip out toward
the abdomen or spinal nerves. The vertebral bodies
may slip on each other.
Risks: When the hardware (instruments placed to hold
the spine together) is placed, nerve roots or the spinal
cord can be injured. In addition, the bone may not
properly fuse. The propensity for non-fusion and continued
pain is higher in smokers. Cessation of smoking improves
the chances of a successful fusion. There can be pain
and the standard risks of bleeding and infection associated
with the site on the body from which the bone for grafting
is taken (often the hip). IIf bone bank bone is used
for grafting, there is an extremely small chance of infection
and HIV. In addition, hardware can break and pull
out from the spine.
Risks: These include general difficulties, such
as bleeding, infection, stroke, paralysis, coma and death.
Incisions on the abdomen and hip generally heal well, but
there may be tenderness, or the wound may heal in an unpleasant
manner. There is also the possibility that the surgery
may not relieve the symptoms for which the procedure was
performed. The problem for which the surgery was performed
may recur, requiring additional surgery in the future.
In addition, although every attempt is made to protect all
areas of the body from pressure on nerves, skin and bones,
injuries to these areas can occur, particularly with prolonged
Anesthesia: Blood clots in the legs, heart attacks,
reaction to the anesthetic, reaction to blood transfusion,
if it given.
shall be no bending, twisting, or heavy lifting for several
weeks after surgery. Physical therapy may or may not
be implicated. Your doctor will gradually ease your
work restrictions, depending on your progress. You will
likely be required to wear a lumbar brace or corset for three
months after surgery.
to keep the wound dry and clean. Notify your surgeon
of any drainage or temperatures greater than 101 Fahrenheit.
of this surgery was to fuse the vertebral bodies in your
back. We expect you to eventually do normal activities
better because of the surgery. Some continuuing back
and leg pain is not unusual during the first few days and
weeks following surgery. Hurt does not necessarily mean
harm. You may experience numbness in the foot or leg,
but this does not impair function. The following is
a list of suggestions that should help speed your recovery
and give you every possible chance for the best results from
upon discharge, contact our office and set up an appointment
for staple removal if one has not already been set up.
it easy until seen by the physician. This does not
mean bed rest, but athletic activities during this period
are definitely not recommended. Please give your incision
a chance to heal. Avoid bending.
your lumbar brace or corset as prescribed by your surgeon.
nothing heavier than a half gallon of milk until seen by
sitting for periods of time longer than 45 minutes.
It is OK to sit in a lounge chair which is laid back, for
as long as you wish.
jogging or running.
you get home, you may begin walking up to one mile per day.
may walk up or down steps as often as you like. Please
take them smoothly and slowly.
driving until OK with your physician. Do not ride
further than 50 miles at a time. This applies
during the first month after surgery.
may shower after you go home unless otherwise instructed.
Cover the incision with plastic wrap before the shower and
remove it afterward. Change dressing immediately.
Tub baths are not advisable. You may shower without
covering the incision one week after the staples are out.
Follow instructions concerning care of tapestrips, stitches
or staples. Your surgeon or his nurse clinician will
explain the techniques used in the closure of your incision.
activities are permitted.
you notice swelling, redness or opening of the incision,
or if there is any clear fluid draining from it, please
contact your surgeon immediately! If you develop a
fever, stiff neck or chills, contact the office immediately.
Take your temperature at 4:00 PM daily until the clips are
removed. Call if greater than 101 degrees Fahrenheit.
you have any questions, call our office, and for after hours
emergencies, call the after hours number.
your medications prescribed on discharge, as directed.
takes 6 - 12 months for a fusion to heal. Be patient.
avoid smoking, as it decreases likelihood of a successful