Everything about ALIF (Anterior Lumbar Interbody Fusion) surgery for back pain

Do you also suffer from back pain that does not go away despite taking medicine, doing physio, and doing everything? Sometimes this pain may even spread from the back to the legs. In such a situation, your doctor may have told you about ALIF surgery. It is normal to feel a little scared when the surgery is mentioned. But don't worry, we will talk about everything in simple terms, what this ALIF surgery is, how it is done, and how to prepare for it.

Simply put, what is ALIF surgery?

The name ALIF may sound a bit complicated, but let's break it down into words.

• A - Anterior: This means "from the front." This means that the surgeon will access your spine through a small incision made on the side of your abdomen .
• L - Lumbar: This refers to the lower part of your back . Most back pain occurs in this area.
• I - Interbody: This means "between two vertebrae." Our spine is made up of small bones (vertebrae) stacked on top of each other. The surgery is performed between two of these vertebrae.
• F - Fusion: This means "to join together".

Imagine that the cushion-like part between two vertebrae in your spine (we call this the intervertebral disk) has worn out. Then those vertebrae rub together, pressing on the nerves that run through them. That's when severe back pain comes.

So, in ALIF surgery, you go through the abdomen and remove the old, worn-out disc, and replace it with a new piece of bone or a small cage made of titanium (graft). Over time, the two vertebrae above and below fuse together with the new piece, becoming one strong bone. Then the nerve compression disappears and the pain subsides.

Who needs this ALIF surgery?

A doctor usually recommends this surgery when other treatments (medication, exercise, physiotherapy) have not helped with back pain. This surgery is mainly used for the following conditions:

• Degenerative Disk Disease: When the discs between the vertebrae wear down with age or due to other reasons, causing pressure on the nerves.
• Lumbar Radiculopathy: Conditions such as pain and numbness that radiate down the legs due to compression of a spinal nerve.
• Spondylolisthesis: The sliding of one vertebra forward over another.
• Scoliosis: Conditions such as curvature of the spine.
• This method may be suitable even for someone who has had several previous back surgeries.

How do you prepare before surgery?

This is not something that can be decided in one day. There are many things that you and your doctor need to plan together. Let's break this preparation down into several parts.

How the surgery is performed

After you are taken to the operating room, the anesthesiologist will put you completely to sleep, so you won't feel any pain.

This surgery is like a team effort. Two surgeons mainly participate in it.

1. Access Surgeon: This doctor's job is to make way for the spine surgeon to access your spine. He or she will make a small incision in your abdomen, about 2-3 inches below your navel. Then, the abdominal muscles, peritoneal sac, and blood vessels will be carefully moved aside to make room for the spinal cord.

2. Spine Surgeon: Now the spine specialist takes over. He or she will completely remove the damaged, worn-out disc. Then, the bone graft or titanium cage (graft) that we talked about earlier will be inserted into the space. If you want it to not move around, small screws will be inserted and fixed.

When this work is finished, the first doctor comes back and puts the intestines, blood vessels, etc. back in place, stitches up the abdominal muscles, and closes the skin incision.

This surgery usually takes about one to two hours, but it may take longer if multiple discs need to be replaced or if you have had previous abdominal surgery.

What happens after the surgery?

After the surgery, you will be kept in a recovery area until you regain consciousness. There, nurses will constantly check your pulse and breathing, and give you pain medication.

Then you will be transferred to the ward. You will have to stay in the hospital for about three to four days. During this time,

• We are carefully monitoring for any signs of infection.
• On the first day after surgery, you will be encouraged to get up and walk around a bit. This is very important for a speedy recovery.

The recovery process

It can take several months to fully recover. You may not be able to lift weights, bend at the waist, or turn your body for several weeks. It can take up to a year for the inserted bone fragment to fully fuse with the vertebrae.

What are the benefits and risks of ALIF surgery?

Like any surgery, this one has benefits as well as minor risks.

Advantages

• This does not damage the muscles behind the back. Because the incision is on the abdomen, there is less pain and less recovery time.
• This method allows for better removal of the disc and insertion of a larger bone fragment than a posterior lumbar intervertebral discectomy (PLIF).
• This method can be used even by someone who has previously had back surgery.

Risks (Complications)

• The risk of infection and excessive bleeding is inherent in any surgery.
• Nerve damage.
• Damage to the intestines, bladder, or blood vessels. (These are very rare)
• Protrusion of the abdominal muscles through the incision (incisional hernia).

Your doctor will explain all of this to you.

When to see a doctor as soon as possible

If you experience any of these symptoms after returning home , call your doctor immediately or go to the hospital's Emergency Department (ETU).

• If you have a fever, feel cold and shiver.
• If the surgical wound is red, swollen, painful to the touch, or oozing pus (these may be signs of infection).
• If the pain is more severe than expected and does not subside even after taking painkillers.

It's normal to feel scared and hesitant when thinking about ALIF surgery. Because you've probably already suffered a lot from back problems. This is a big decision in your life. So talk to your doctor about all your questions and fears. They will explain everything to you and help you make the best decision.