Introduction
The Anterior Lumbar Interbody Fusion (ALIF) technique was first reported in the 1960s. In its early stage, ALIF was mainly used for the treatment of spinal tuberculosis, and later gradually expanded to other related spinal diseases. Despite the continuous evolution of ALIF - related standard technologies and implantable devices with subsequent technological advancements, its core therapeutic principle remains unchanged: resecting the intervertebral disc via an anterior approach, placing a fusion cage or a large bone graft in the intervertebral space to maintain the disc height and anterior vertebral stability, and ultimately achieving bony fusion of the vertebrae.
Surgical procedure
1、Positioning and incision design
Traditional and Modified Approaches of ALIF.The traditional approaches for Anterior Lumbar Interbody Fusion (ALIF) include the midline transperitoneal approach and the anterolateral retroperitoneal approach. With the advancement of minimally invasive concepts, the traditional approaches have been modified into the mini-open anterior approach. A transverse incision (3-5 cm in length) is made slightly left of the abdominal midline at the corresponding vertebral level, which can be performed via either a transperitoneal or retroperitoneal route.
①The transperitoneal approach, a relatively older technique, is increasingly less commonly used. It carries the risk of injuring the peritoneum and the superior/inferior hypogastric plexuses, as well as may lead to iatrogenic secondary intestinal atrophy surrounding fibrotic scar tissue. However, it remains a viable option for patients in whom retroperitoneal dissection is not feasible due to a history of multiple prior abdominal surgeries, or for those requiring revision surgery via an anterior spinal approach.
② The retroperitoneal approach can be performed via the left or right side at the L5/S1 level. On one hand, it avoids the obstruction of the liver in the surgical field; on the other hand, since the inferior vena cava is located anterior to the right side of the spinal column, the risk of injury to the inferior vena cava during the operation can be reduced.
③ The aponeurosis of the external oblique abdominis is incised, and the fibers of the external oblique abdominis are separated to expose the internal oblique abdominis, transversus abdominis, transversalis fascia, and peritoneum. Extraperitoneal fat is seen bulging from the incision, and the lateral peritoneum, together with the ureter, is retracted toward the midline using saline-soaked gauze until reaching the anterior aspect of the vertebral body. The operation is performed in the triangular area between the bifurcation of the iliac veins and the sacral promontory. If necessary, the median sacral artery is ligated to achieve adequate exposure.
4、Postoperative rehabilitation
Postoperative patients should wear a lumbar brace to limit movement of the lumbar spine, promote fusion, and prevent the intervertebral fusion device from dislodging.
Features: The lumbar self-stabilizing interbody fusion cage is a hollow rectangular fusion device mounted on a titanium alloy plate, with tantalum markers attached. It is used for vertebral body fusion and is available in multiple models with varying heights, surface areas, and lordotic angles to accommodate the anatomical differences among different patients.
