During an anterior lumbar interbody fusion, the spine is approached from the front of the body. A three-inch incision is made on the left side of the abdomen and the abdominal muscles. Anterior lumbar fusion procedures are performed as an open surgery to provide clear visualization of the discs space and vasculature. The procedure removes part or all of a damaged disc between two adjacent vertebrae in the lumbar spine. Those vertebrae are fused using bone graft or bone graft substitute. These procedures can be done in conjunction with another spinal fusion approach, such as posterior decompression, posterior screws, or anterior plating.
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There are numerous reasons a surgeon may recommend spinal fusion. This procedure is used to treat:
Patients with low back and leg pain due to an unstable spine, damaged vertebrae, or discs that did not respond to non-surgical treatment measures may be candidates for anterior lumbar interbody fusion. Individuals without an excessive amount of spinal instability or slippage who have little to no spinal stenosis or nerve compression are good candidates for a stand-alone anterior lumbar fusion procedure. However, patients with osteoporosis or arthritis are not recommended for stand-alone anterior lumbar interbody.
Anterior lumbar fusion is a well-tolerated procedure associated with less pain and a faster recovery than spinal fusion surgery performed from the back of the spine. The procedure allows for a much larger cage placement than other spinal fusions, which provides more stability and a higher chance of fusing solidly. It allows for better correction of spinal deformity or imbalance, resulting in better long-term outcomes relating to pain, quality of life, and reducing the chance of developing problems at other spine levels.
The patient is positioned on their back and sedated under general anesthesia. The surgeon then makes an incision in the abdomen and retracts the abdominal muscles, organs, and vascular structures (including blood vessels) for a clear view of the front of the spine and access to the vertebrae. A general surgeon or vascular specialist may perform this section of the procedure.
Once the incision is made, all parts of the damaged or degenerated discs are removed from the affected area. After removing the damaged discs, a bone graft (or bone graft substitute) is placed into the disc space between the vertebral bodies to support the disc space and promote bone healing. The abdominal organs, blood vessels, and muscles are returned to their regular place, and the incision is closed.
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