ALIF Surgery // Anterior lumbar interbody fusion
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- čas přidán 9. 07. 2024
- Brought to you by Dr. John Edwards, neurosurgeon at Summit Brain and Spine, as part of the Summit Medical Institute
This video discusses everything you need to know about an anterior lumbar inter body fusion or ALIF. Including what it is and who its for, the advantages, the surgery itself, the risks, and the recovery
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0:00 intro
0:11 overview
0:55 advantages
1:12 surgery
2:38 after surgery expectations
3:25 risks
4:29 summary
Transcript:
I want to talk about an anterior lumbar interbody fusion, or ALIF.
Anterior means through the front. And lumbar is obviously the low back. Inter body means that disk and fusion means we're doing a fusion. So, A L I F or ALIF, what is it? What are the risks? Why would we recommend it? So, in some patients, fusion surgery is recommended. And an anterior fusion is one technique or way of accomplishing a lumbar fusion, I like to recommend anterior lumbar interbody fusion, in particular, at the bottom disc L5S1. And the advantages of the approach is we can really open up the disk space with it, we can also give you a better curve and your low back then we are able to coming in through the back. And then the final thing is that we're not affecting any of the muscle in the low back, because we're going in through the front. Now, the approach is done by an incision in the low abdomen by the general surgeon. And there's a pathway to get to the spine, that is through a fascial layer or a fat layer underneath the abdominal wall. So to get there, there's very little muscle that's cut. And the approach morbidity, or the pain associated with the approach is really relatively low in most cases. Once the general surgeon gets down to the spine, the biggest risk of surgery occurs, which is there are these iliac arteries and veins, large blood vessels in front of the spine. And the most important thing with the surgery is to get those blood vessels behind the retractor, and out of the way of the surgery. Once the hard part's done, I scrub in and remove the disk and put in the implant and some screws. We also put in cadaver bone, we don't really have enough of your own bone to do the fusion, so we have to put in cadaver bone. That portion of the surgery typically takes about 20 to 30 minutes, and is relatively straightforward to do. Once the implant is in and the disc is completely out and we're happy, then the general surgeon proceeds with the closure. The patients typically after surgery will refrain from eating anything until the next morning, we want to give the bowels a little bit of time to wake up. And then the diet is gradually advanced as tolerated. Some patients will leave the hospital the afternoon after surgery. And then I would say the rest of them maybe 50 60% With leave the second day. So two nights in the hospital, the patients will have some abdominal pain, they may actually have a little bit of back pain from opening that disk up. But the recovery and the pain is generally well tolerated. It takes about four to six weeks for you to feel like you're back on your feet and moving and engaging in your daily activities without significant symptoms. The main risk of the surgery again is injury to one of those major vessels. The other risk, I would say is that the level that was intended to be fused, doesn't actually go on to fusion. That risk is maybe two or 3% which may require another surgery. The anterior lumbar interbody fusion surgery is a very successful operation. That spares the muscle in the back has a reasonably good recovery period and is associated again with a modest risk of injury to one of those major blood vessels. We recommend it in patients particularly at L5S1 sometimes L4/5 but the bottom disc is the most common and the main reason that we recommend it is to restore the disc height and the curve in the low back. And we've seen pretty good success with the anterior lumbar inter body fusion.
I had a two level ALIF and a single level total disc replacement. L4/5 L5/S1 had the ALIF and L3/4 got the total disc replacement. BMP was used in the fusion to ensure a solid union was formed. A lot of days I am 100 percent pain free, but I do have some days where I am not. Overall a pretty good result six years out
That's great to hear, glad you are doing well.
Thank you for taking the time to make this video. I would definitely recommend ALIF over ADR at L5-S1 given it's more of a loading disc.
I'm sorry but 4-6 weeks recovery time isn't accurate. Working with a lot of patients I can now confidently say. There's a minor population who can be pain free and functional within 3 months ie 12 weeks but there are A LOT of that can easily take up to the year to fully recover from ANY spinal surgery.
I feel this 4-6-8 weeks recovery time a marketing pitch.
Hey Doctor! I know an ALIF only gets about 90 percent of the disc because of the frontal approach. What happens to that remaining bit of disc? Can't it still be compressed on the nerve? Will it eventually erode/absorb?
I had ALIF done 3 months ago. The surgery went well (except one of the three screws for the plate was missing from the operating room, the hospital had to get a screw from a nearby hospital, a 2hr surgery turned into 4hrs)
I was up and walking right after I got to my room, had a light dinner of hummus and pita bread later that evening. They released me the next day in the afternoon after having an enema to get my digestive system going again.
I was almost pain free for the first 5 weeks, then the pain began to really set in. Now, 12 weeks out the pain is beginning to subside, I’m finally able to remove my body vest and start physical therapy. I hope to get back to feeling “normal” soon, although I know it’s still going to take time for the fusion to fully heal.
BTW the hospital had a backup plan if they ruptured one of the arteries. All the blood would have been recovered/filtered and replaced.
How do you feel now? Hoping still good results!
All the best from Maryland where we have a friend soon to go through this, likely also anterior. So thanks for sharing.
@@Shanopla Hi,
I’m doing ok, still in recovery. There are days/weeks where I feel great then suddenly I’m in a lot of pain. That generally happens when I do too much bending over. It’s difficult not to, especially in the summer (here in Michigan) when I’m maintaining our house and property.
The ALIF surgery is pretty intense, having my organs shifted around and my spine opened up has taken a long time to recover from. In fact, my neurosurgeon said that it takes about a year to fully recover, sometimes longer.
I went back to work 4 months post op and realized shortly after that I could no longer perform my job as a steel worker. At 45 yrs old and having done a pretty good toll on my body for the last 30yrs I’ve decided to retire(temporarily).
One piece of advice I would strongly encourage for your friend is to go to physical therapy as much and as often as possible. In the beginning it may seem like a waste of time but it will dramatically improve mobility and healing.
@@tomstirdivant37 Wow, I am so sorry that after so many months the challenges continue, and also the inability to work in your field (such an important one!) even if temporarily. I spoke to my friend and he appreciates so much your time in replying and will follow your advice - it makes sense to maximize on the front end not wait. We have taken it to heart. Will keep you in prayer and that sooner than expected you see a great improvement. Best, Shane and Fred
@@Shanopla .
Dude thank you so much! I can’t wait to get this surgery, I’ve been blown up and set on fire before this pain is going to be nothing in comparison LOL
hey mate did you end up getting it done?
@@varuninnz I get it done September 13. Scared to death it’s gonna make me worse. But most of what I read is that it helps tremendously
@@FromTheHood2TheWoods Are you getting PEEK cage or metal cage?
@@varuninnz I don’t know they didn’t tell me anything? I guess I need to ask, thank you
@@FromTheHood2TheWoods I would highly recommend you to get a PEEK cage because you'll be able to get MRI after. Metal cages cause scattering.
My spinal surgeon said another risk of sexual disfuncion after ALIF due to possible nerve demage
Yes if the Dr decides to just cut through the nerves instead of carefully dissect them, goodbye erection