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Anterior Lumbar Interbody Fusion (ALIF)

Overview

What is ALIF?

Anterior Lumbar Interbody Fusion (ALIF) is a spinal procedure used to treat lower back pain, instability and nerve compression due to degenerative disc disease, spondylolisthesis or other conditions affecting the lumbar spine. This approach accesses the spine through the abdomen and allows the placement of a spacer (bone graft or cage) between the vertebrae, restoring disc height and promoting fusion.​

Who is it for?

If you are experiencing symptoms not relieved by physiotherapy, medications or injections, and imaging has confirmed disc damage or instability, you may be a candidate for ALIF.

ALIF is considered for patients with persistent low back pain, leg pain or weakness resulting from:

  • Degenerative disc disease
  • Spondylolisthesis (slippage of vertebrae)
  • Recurrent disc herniation
  • Spinal stenosis
  • Failed previous surgery or revision
  • Multilevel disease in the lower lumbar region

What the Procedure Involves

Here is what typically happens during an ALIF:

  • Under general anaesthesia, a vascular surgeon creates a small incision (usually 7–10cm) in the lower abdomen.​
  • Abdominal muscles and organs are gently moved aside to expose the spine without cutting through back muscles.
  • The affected disc is carefully removed, and the disc space is prepared for fusion. Nerves and blood vessels are gently protected throughout.
  • A spacer (bone graft or cage) filled with bone material is placed between the vertebrae to restore height and decompress nerves. Plate and screws may be added for extra stability.​
  • The incision is closed, and you are monitored in recovery.
    The procedure typically takes 1–2 hours, depending on how many levels are fused.

Risks and Complications

While ALIF is a common procedure, it does entail specific risks. These can include:
Potential complications include:

  • Infection (1–4% risk)​
  • Injury to large blood vessels (1–15%, unique to ALIF approach)​
  • Blood loss or need for transfusion
  • Injury to nerves or spinal cord
  • Dural tear (spinal fluid leak)
  • Fusion failure (nonunion), which may require revision surgery
  • Deep vein thrombosis (blood clots)​
  • Persistent or chronic pain
  • Injury to abdominal organs (rare)
    Most complications are uncommon and your surgeon will take steps to minimise these risks.

Recovery Expectations and Duration

After surgery, most patients experience:

  • A hospital stay of 3–7 days, sometimes shorter if single-level fusion​
  • Initial pain and soreness for several days, managed by medication and gentle mobilisation
  • Light activity usually resumes in 4–6 weeks, while soft tissues heal​
  • Bone fusion strengthens over 3–6 months; physical or strenuous activities are avoided until healing is confirmed
  • Full recovery and return to normal activities can be expected around 6–12 months, once fusion is complete​

Regular follow-ups and imaging help monitor your progress. Most patients notice significant improvement in leg and back pain over weeks, with gradual restoration of everyday mobility.

FAQs

Will I have a scar from ALIF?
Yes, you will have a scar in your lower abdomen (usually 7–10 cm). It is placed in a way that is often discreet under clothing.

Will my movements be restricted after ALIF?
Fusion stops movement at the treated level, but most people retain good function. Some reduction in flexibility is possible if multiple levels are fused.