Anterior lumbar interbody fusion (ALIF) allows surgeons to reach the last lumbar vertebra from the abdomen, allowing for a better fusion and preservation of normal back anatomy.
Tiger Woods’ back surgery – anterior lumbar interbody fusion (ALIF) surgery – performed just less than two years before his comeback victory in the 2019 Masters is a less invasive way to repair the lowest disc in the spine at the pelvis.
Tiger had three previous surgeries to relieve pain in the very bottom of his lumbar spine. The disc was severely narrowed, leading to pain in his back and leg. Conservative treatments with physical therapy and medications were not working.
Tiger announced in April 2017 on his website that he chose to have an ALIF performed — allowing removal of the degenerated disc from between the last lumbar vertebra (L5) to the top of the sacrum (S1) — the triangular formation of bones in the pelvis. Surgeons restored the appropriate alignment between the vertebra and the sacrum, then fused the bones together.
Because surgeons approach the joint from the abdomen, muscles and nerves in the lower back are spared. The preservation of normal lower back muscle and ligaments has many benefits — particularly in patients with an active lifestyle.
The approach also allows surgeons to restore normal alignment and place bone graft between the affected vertebrae. The graft material and restored alignment is held in place with a mesh cage or interbody device. Over time, the graft material incorporates, allowing for the lumbar vertebra and the sacrum to grow into a single bone.
Posterior approaches usually allow the graft to be placed across the back of the vertebrae.
Innovative ALIF approaches
ALIF is one of the more common procedures for Norton Leatherman Spine surgeons, who choose an innovative route to the hard-to-reach L5/S1 disc space. They’ve determined that going through the peritoneum — the membrane covering the abdominal organs — rather than behind it provides a more direct route to the disc space with improved efficiency in the operating room and less risk of post-operative complications.
“ALIF can be a life-restoring option for patients who’ve tried conservative treatments with incomplete pain relief,” said Joseph L. Laratta, M.D., an orthopedic spine surgeon with Norton Leatherman Spine, specializing in minimally invasive techniques. “For some patients, approaching the diseased spine from the front allows for a better fusion and a return to golf and other activities. The complete preservation of the lower back muscles and ligaments is one of our main principles in minimally invasive spine surgery.”
Norton Leatherman Spine
The surgeons at Norton Leatherman Spine have the experience to know when surgery can help back pain and when more conservative steps are all that’s needed.
For fusions higher in the spinal column, Dr. Laratta often approaches the vertebrae to be fused from the side. While the L5/S1 fusion is too low on the spine to allow for a lateral approach, others can be reached this way.
Extreme lateral interbody fusion (XLIF) is a procedure that does not involve any cutting of muscle. Instead, tissue planes are dilated with small tubes — allowing for fusion with smaller incisions and quicker recovery. More than 90 percent of patients go home the day after surgery.
Dr. Laratta advances the procedure further by harvesting stem cells from the patient and applying them to the graft to achieve a solid fusion in more than 97 percent of patients.
Anterior lumbar interbody fusion recovery time
Patients routinely are up and around hours after ALIF surgery. Because it takes about three to six months for the graft material to fuse the vertebrae, patients will need to avoid strenuous activity, but must rehabilitate the muscles with supervised exercise.
Patients can resume work as early as a week or two after surgery or months later, depending on their occupation and symptom severity.