ALIF (Anterior Lumbar Interbody Fusion)

Overview

ALIF — Anterior Lumbar Interbody Fusion — accesses the lumbar spine through the front of the body (the abdomen) rather than the back. This approach has several unique advantages: the abdominal muscles are not cut, the powerful back muscles are completely undisturbed, and the entire disc space is directly visible for complete disc removal and large cage placement. ALIF is particularly effective at restoring disc height, correcting spinal alignment, and achieving high fusion rates because the anterior disc space has excellent blood supply. Dr. Basques works alongside a board-certified vascular surgeon who provides the anterior exposure — safely moving aside the abdominal contents and major blood vessels — while Dr. Basques performs the spinal portion of the procedure. ALIF is commonly used for L5-S1 and L4-L5 degenerative disc disease, spondylolisthesis, and post-laminectomy instability.

How It Works

Under general anesthesia, the patient lies on their back. The vascular surgeon makes an incision in the lower abdomen (typically a horizontal incision below the belly button or a vertical midline incision). The rectus abdominis muscles are separated along their natural midline rather than cut. The peritoneum (the sac containing the intestines) is retracted to expose the front of the lumbar spine. Dr. Basques confirms the correct level with X-ray, then performs a complete discectomy — removing virtually all of the damaged disc. The disc space is prepared and distracted to restore normal height. A large cage packed with bone graft material (and sometimes a bone morphogenetic protein) is inserted into the disc space. The cage is sized to maximize surface contact area for fusion. The retractors are removed, and the abdominal incision is closed. If additional posterior stabilization is needed, the patient may be repositioned for posterior screw placement (either the same day or staged). The anterior portion typically takes 60–90 minutes.

Benefits

Who Is a Candidate?

Ideal candidates have L5-S1 or L4-L5 degenerative disc disease, spondylolisthesis, post-laminectomy instability, or failed posterior fusion (pseudarthrosis) requiring revision. ALIF is particularly well-suited for L5-S1 pathology because the anterior approach provides direct, unobstructed access to this level. Patients with significant vascular disease or prior abdominal surgery may not be candidates. Dr. Basques evaluates each case with the vascular surgeon to ensure safe anterior access.

Recovery & Aftercare

Hospital stay is typically 1–3 days. A brief period of no driving and limited bending is required. Light activities resume after 2–3 weeks. Return to desk work is typically 4–6 weeks. Heavy lifting is restricted for 3–6 months. The abdominal incision heals well, usually fading to a thin line. Because the back muscles are completely untouched, back pain from the surgical approach is minimal. Dr. Basques provides detailed recovery instructions.

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