What it is
ALIF approaches the lumbar disc from the front of the body rather than the back. A vascular surgeon or access surgeon assists with retracting the great vessels (aorta and inferior vena cava or iliac vessels) to expose the front of the lumbar spine. The disc is removed through this anterior corridor, and a large interbody device — filled with bone graft — is placed directly into the disc space.
The anterior approach is most practical at L4-5 and L5-S1, where anatomy allows safe vessel retraction.
Why go anterior
The anterior approach to the lumbar spine offers specific advantages for certain patients:
- Large graft footprint — the disc space can be prepared thoroughly and a larger implant placed, improving fusion surface area and alignment correction
- Lordosis restoration — anterior disc height is most effectively restored from the front, helping correct flat-back deformity or loss of lumbar lordosis
- No posterior muscle disruption — the back muscles and posterior nerves are untouched, which matters particularly in revision surgery where posterior scarring makes re-entry hazardous
- Full disc removal — the entire disc can be removed from the front, which is relevant when discogenic pain is the primary driver
ALIF is often combined with posterior percutaneous pedicle screws placed through small separate incisions to complete the fixation construct — a "hybrid" approach that avoids a full open posterior surgery.
What to expect
ALIF is performed under general anesthesia, usually requiring two to three nights in the hospital. The most notable risk specific to anterior lumbar surgery is retrograde ejaculation in men from manipulation of the superior hypogastric plexus — patients should be counseled about this before surgery. Vascular injury and approach-related complications are managed by the access team.