Anterior Lumbar Interbody Fusion (ALIF): Technique Video: 2-Dimensional Operative Video

Abstract This surgical video demonstrates the technique of an anterior lumbar interbody fusion (ALIF). This video demonstrates the surgical approach, technical nuances of ALIF, and pearls. The main surgical anatomy and approach-related risks are discussed. The video demonstrates the nuances of ALIF, discussing the importance of the release of the disc space to allow for height restoration and lordosis, endplate preparation to enhance arthrodesis, and choice of implant size. The incision is made via a left paramedian approach with a retroperitoneal dissection and mobilization of the vasculature for access to the disc space. The ALIF provides direct access to the ventral surface of the exposed disc, allowing for an incision of the anterior longitudinal ligament, bilateral release of the annulus fibrosus, and access to a large surface area of the vertebral endplate. This anterior access allows for the placement of implants with a greater surface area for fusion, and this facilitates restoration of segmental lordosis, disc height improvement, and foraminal height increase. We have received informed consent from this patient for the video of this case.

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Radiographic comparison of lordotic and hyperlordotic implants in L5–S1 anterior lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2021.7.spine202221 ◽

2021 ◽

pp. 1-9

Author(s):

S. Harrison Farber ◽

Soumya Sagar ◽

Jakub Godzik ◽

James J. Zhou ◽

Corey T. Walker ◽

...

Keyword(s):

Lumbar Lordosis ◽

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Single Level ◽

Single Segment ◽

Upright Standing ◽

Segmental Lordosis ◽

Level Fusion

OBJECTIVE Anterior lumbar interbody fusion (ALIF) used at the lumbosacral junction provides arthrodesis for several indications. The anterior approach allows restoration of lumbar lordosis, an important goal of surgery. With hyperlordotic ALIF implants, several options may be employed to obtain the desired amount of lordosis. In this study, the authors compared the degree of radiographic lordosis achieved with lordotic and hyperlordotic ALIF implants at the L5–S1 segment. METHODS All patients undergoing L5–S1 ALIF from 2 institutions over a 4-year interval were included. Patients < 18 years of age or those with any posterior decompression or osteotomy were excluded. ALIF implants in the lordotic group had 8° or 12° of inherent lordosis, whereas implants in the hyperlordotic group had 20° or 30° of lordosis. Upright standing radiographs were used to determine all radiographic parameters, including lumbar lordosis, segmental lordosis, disc space lordosis, and disc space height. Separate analyses were performed for patients who underwent single-segment fixation at L5–S1 and for the overall cohort. RESULTS A total of 204 patients were included (hyperlordotic group, 93 [45.6%]; lordotic group, 111 [54.4%]). Single-segment ALIF at L5–S1 was performed in 74 patients (hyperlordotic group, 27 [36.5%]; lordotic group, 47 [63.5%]). The overall mean ± SD age was 61.9 ± 12.3 years; 58.3% of patients (n = 119) were women. The mean number of total segments fused was 3.2 ± 2.6. Overall, 66.7% (n = 136) of patients had supine surgery and 33.3% (n = 68) had lateral surgery. Supine positioning was significantly more common in the hyperlordotic group than in the lordotic group (83.9% [78/93] vs 52.3% [58/111], p < 0.001). After adjusting for differences in surgical positioning, the change in lumbar lordosis was significantly greater for hyperlordotic versus lordotic implants (3.6° ± 7.5° vs 0.4° ± 7.5°, p = 0.048) in patients with single-level fusion. For patients receiving hyperlordotic versus lordotic implants, changes were also significantly greater for segmental lordosis (12.4° ± 7.5° vs 8.4° ± 4.9°, p = 0.03) and disc space lordosis (15.3° ± 5.4° vs 9.3° ± 5.8°, p < 0.001) after single-level fusion at L5–S1. The change in disc space height was similar for these 2 groups (p = 0.23). CONCLUSIONS Hyperlordotic implants provided a greater degree of overall lumbar lordosis restoration as well as L5–S1 segmental and disc space lordosis restoration than lordotic implants. The change in disc space height was similar. Differences in lateral and supine positioning did not affect these parameters.

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5:5643. Anterior Lumbar Interbody Fusion for Degenerative Disc Disease: A Stratified Patient Population With Preoperative MRI Findings of Disc Space Collapse and Cartilaginous End Plate Erosion

The Spine Journal ◽

10.1016/j.spinee.2006.06.061 ◽

2006 ◽

Vol 6 (5) ◽

pp. 21S

Author(s):

Peter Ullrich ◽

David DeWitt ◽

Pamela Verkuilen ◽

Sherry Meyer

Keyword(s):

Degenerative Disc Disease ◽

Patient Population ◽

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Mri Findings ◽

Disc Disease ◽

Disc Space ◽

Degenerative Disc ◽

End Plate

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Anterior Lumbar Interbody Fusion (ALIF) versus Oblique Lateral Interbody Fusion (OLIF) at L5-S1: A Comparison of Two Approaches to the Lumbosacral Junction

Neurosurgery ◽

10.1093/neuros/nyz310_336 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Zhuo Xi ◽

Shane Burch ◽

Chih-Chang Chang ◽

Hui-bing Ruan ◽

Charles M Eichler ◽

...

Keyword(s):

Blood Loss ◽

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Disc Height ◽

Lumbar Interbody Fusion ◽

Lateral Interbody Fusion ◽

Height Increase ◽

Segmental Lordosis ◽

Oblique Lateral Interbody Fusion ◽

Lateral Interbody

Abstract INTRODUCTION The oblique lateral interbody fusion OLIF is an alternative anterior approach to the lumbar spine at L5-S1, and it is unknown how it compares to anterior lumbar interbody fusion ALIF. This abstract is to compare the radiographic and clinical factors of ALIF and OLIF at L5-S1 only. METHODS A retrospective review of patients who underwent ALIF or OLIF at L5-S1 only at the University of California San Francisco (2013-2018) was performed. Data collected were demographics, cage parameters, perioperative factors, and radiographic parameters. RESULTS A total of 58 patients were included (33 ALIF and 25 OLIF). The average surgical time was 211.94 min for ALIF and 154.86 min for OLIF (P < .001). The average blood loss was 214 ml for ALIF and 74 ml for OLIF (P < .001). The average day to solid food was 2.55 for ALIF and 0.8 for OLIF (P < .001). The average cage height was 14.78 mm for ALIF and 12.9 mm (P < .001) for OLIF. The average cage lordosis was 15.45° for ALIF and 12.68° (P = .76) for OLIF. Average anterior L5-S1 disc height increase was 8.52 mm (ALIF) and 5.02 mm (OLIF) (P = .018), and average posterior L5-S1 disc height increase was 3.34 mm (ALIF) and 1.30 mm (OLIF) (P = .034). The average L5-S1 segmental lordosis increase was 6.82° for ALIF and 7.63° for OLIF (P = .638). CONCLUSION Patients who underwent OLIF at L5-S1 had shorter ileus duration compared to ALIF and comparable operative times and blood loss. ALIF afforded larger cages to be placed, resulting in greater disc height, but there was no significant difference in L5-S1 segmental lordosis.

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Mini-open anterior lumbar interbody fusion

Neurosurgical FOCUS ◽

10.3171/2016.2.focusvid.1695 ◽

2016 ◽

Vol 41 (videosuppl1) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Gurpreet S. Gandhoke ◽

Christian Ricks ◽

Zachary Tempel ◽

Brian Zuckerbraun ◽

D. Kojo Hamilton ◽

...

Keyword(s):

Interbody Fusion ◽

Pubic Symphysis ◽

Anterior Lumbar Interbody Fusion ◽

Sacral Slope ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Lower Lumbar Spine ◽

Great Vessels ◽

Lower Lumbar ◽

Mini Open

In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure.The video can be found here: https://youtu.be/r3bC4_vu1hQ.

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Comparison of Disc Space Heights after Anterior Lumbar Interbody Fusion

Spine ◽

10.1097/00007632-198908000-00019 ◽

1989 ◽

Vol 14 (8) ◽

pp. 876-878 ◽

Cited By ~ 124

Author(s):

STEVEN DENNIS ◽

ROBERT WATKINS ◽

STEPHEN LANDAKER ◽

WILLIAM DILLIN ◽

DONALD SPRINGER

Keyword(s):

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Disc Space

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90. The effect of preoperative disc space height on clinical outcomes after anterior lumbar interbody fusion

The Spine Journal ◽

10.1016/s1529-9430(03)00273-0 ◽

2003 ◽

Vol 3 (5) ◽

pp. 109-110

Author(s):

Thomas Schuler ◽

J.Kenneth Burkus ◽

Matthew Gornet ◽

Thomas Zdeblick

Keyword(s):

Clinical Outcomes ◽

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Disc Space

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RADIOGRAPHIC ANALYSIS OF THE RESULTS OF ANTERIOR INTERNODY ARTHRODESIS ON THE SAGITTAL LUMBOPELVIC PARAMETERS

Coluna/Columna ◽

10.1590/s1808-185120201902224026 ◽

2020 ◽

Vol 19 (2) ◽

pp. 104-107

Author(s):

FELIPE DE NEGREIROS NANNI ◽

EMILIANO NEVES VIALLE ◽

MARVIN DURANTE BRUNET

Keyword(s):

Lumbar Lordosis ◽

Interbody Fusion ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

Degenerative Spondylolisthesis ◽

Anterior Lumbar Interbody Fusion ◽

Sacral Slope ◽

Lumbar Interbody Fusion ◽

Pelvic Parameters ◽

Segmental Lordosis

ABSTRACT Objective The objective of this study is to analyze the radiographs of patients who underwent anterior lumbar interbody fusion (ALIF), to compare the values of the lumbopelvic measurements, and to quantify improvements in these parameters achieved through this technique. Methods The radiographs of 42 patients, all submitted to ALIF with a 12° interbody device, were evaluated from a database at a single center. The pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, segmental lordosis, and regional lordosis angles of each patient were measured in pre- and postoperative radiographs. Results We observed a discreet change in the pelvic parameters and a marked increase in regional lordosis with a mean increase of 5.8° (p>0.001). Segmental lordosis also showed a mean increase of 2.43°. The gain in segmental lordosis was even higher in patients with degenerative spondylolisthesis and when the operated level was L5-S1. Conclusions The ALIF technique in the lumbar spine is capable of significantly increase the lordosis of a segment, whether at one or two levels. Greater improvement in the lumbopelvic parameters was observed it the procedures performed in level L5-S1 and in cases that presented spondylolisthesis.

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Feasibility of Endoscopic Transforaminal Lumbar Interbody Fusion(eTLIF) through the Posterior Paraspinal Approach: Technical Note and Preliminary Result

10.21203/rs.3.rs-28307/v2 ◽

2020 ◽

Author(s):

Hyeun-Sung Kim ◽

Harshavardhan Dilip Raorane ◽

Pang Hung Wu ◽

Dong Hwa Heo ◽

Yeon Jin Yi ◽

...

Keyword(s):

Lumbar Lordosis ◽

Interbody Fusion ◽

Plain Radiograph ◽

Transforaminal Lumbar Interbody Fusion ◽

Disc Height ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Paraspinal Approach ◽

Segmental Lordosis

Abstract Background: Implementation of endoscopic spine surgery in the management of degenerative lumbar diseases has significantly reduced the need for fusion surgeries. The performance of a MIS-TLIF using an endoscope offers some distinct advantages, such as allowing better visualization the disc space, enhanced endplate preparation and contralateral decompression. The objective of this study was to analyze the preliminary clinical and radiological outcomes of the technique of endoscopic transforaminal lumbar interbody fusion (eTLIF).Materials and Methods: eighteen consecutive patients with degenerative lumbar disease underwent eTLIF through a conventional paraspinal approach. Their clinical outcomes were evaluated with visual analog scale(VAS) leg pain score, Oswestry Disability Index(ODI) and the MacNab's criteria; radiological outcome measured with segmental lordosis, global lumbar lordosis, disc height on plain radiograph and percentage of potential fusion mass on CT scan at pre-operative, post-operative and final follow up period. Intra operative and post-operative complications were noted.Results: Mean age was 63. 71 years and Mean follow-up periods was 7.78 months. In the X-ray result, mean segmental lordosis angle(SLA) improved in pre-operative/post-operative/follow-up period 9.87±2.74 degree/ 11.79±3.74 degree/ 10.56±3.69 degree (p > 0.01); mean lumbar lordosis angle(LLA) improved 37.1±7.04 degree/ 39.2±7.13 degree/ 35.7±7.25 degree (p > 0.01). Mean preoperative disc height(DH) improved from 8.97±1.49 mm/ 12.34±1.39 mm/ 11.44±1.98 mm (p < 0.01). In the CT result, Average percentage of fusion mass was 42.61%. VAS was improved significantly, 7.67±1.13 / 3.39±1.38 / 2.5±1.34 and ODI was improved significantly, 74.9±8.03/ 34.56±8.80 / 27.76±8.64 by each preoperative / postoperative / final follow-up. In the clinical result, excellent was 5 cases and good was 13 cases. Conclusion: According to the results of this study, endoscopic TLIF was feasible procedure with an advantage of better visualization and preservation of endplate, minimal blood loss and minimal post-operative pain with early mobilization. In addition, the fusion volume as measured on post-operative CT scans, occupied 40% to 50% of disc space along with the use of 3D printed cages expected to give higher fusion rates. In conclusion, our preliminary results show that endoscopic TLIF is considered to be a viable surgical procedure with further long-term follow-up warranted.

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