Anterior Lumbar Interbody Fusion (ALIF)

Has your doctor recommended anterior lumbar interbody fusion (ALIF) surgery? It is a common spinal fusion procedure used to treat degenerative disc disease and other conditions that cause nerve compression, instability, deformity, or pain in the lumbar spine. When more conservative treatments do not provide relief, ALIF surgery may be the best approach to alleviate your lower back pain and stabilize your spine.

At Hoag Orthopedic Institute, our board-certified, fellowship-trained surgeons specialize in anterior spinal fusion and ALIF procedures. Their expertise ensures precise treatment to help restore mobility and improve quality of life.

But what is anterior lumbar interbody fusion, and what can you expect if you choose to have the procedure? Here’s what you need to know about ALIF surgery, how it works, and how it may help you regain your active lifestyle.

What is Anterior Spinal Fusion Surgery?

When a disc in the lumbar spine is damaged, herniated, or collapsed, the proper spacing between two vertebrae is compromised. The damaged disc can press on nearby nerves, causing persistent lower back pain, numbness, or radiating leg pain. It can lead to spinal instability and limit your mobility. Anterior lumbar interbody fusion is a spinal fusion surgery that removes the damaged disc, re-establishes the proper spacing between the vertebrae, and restores the spine’s stability.

ALIF surgery replaces the damaged disc with a bone graft or implant. Over time, the implant fuses with the vertebrae above and below it into a single, solid bone.
It is the anterior approach that sets the ALIF procedure apart from other lumbar fusion surgeries. Instead of making an incision on the back (a posterior approach), the surgeon accesses the spine through the front of the body via a small incision in the abdomen.

ALIF surgery’s anterior approach allows direct access to the damaged disc and avoids cutting through back muscles and nerves. As a result, patients often experience less postoperative pain and a shorter recovery time. Because it uses a small incision and avoids cutting major muscles, anterior lumbar interbody fusion is described as “minimally invasive,” though it is still considered a major spinal surgery.

When is ALIF Surgery Recommended?

Herniated discs can heal, and many patients recover from symptoms caused by degenerated discs with conservative treatment, such as physical therapy, steroid injections, and pain medications. However, when noninvasive treatments do not provide pain relief or spine stability, spinal fusion surgery becomes a consideration. If an anterior approach is appropriate, an ALIF procedure may be recommended.

A surgeon may decide that an anterior approach provides safer or more effective access to the spine. This is especially beneficial for patients who have undergone multiple posterior spinal surgeries, as operating in the same area again may increase risks and complications. Other benefits of the anterior approach of an ALIF surgery include:

• Direct access to the damaged disc
• Less disruption to spinal nerves
• Potential for a faster recovery

Anterior lumbar interbody fusion can be used to treat more than damaged discs. Other spinal conditions that may benefit from this surgery include:

• Lumbar radiculopathy (nerve pain due to spinal compression)
• Spinal instability
• Spondylolisthesis (when one vertebra slips over another)
• Certain types of lumbar fractures
• Adult degenerative scoliosis

What to Expect During ALIF Procedure

ALIF surgery is performed while the patient is under general anesthesia and usually takes about two hours. The procedure follows two key steps: First, the surgeon makes a small incision in the abdomen to access the spine. Next, the damaged disc is removed and replaced with a spacer (called a “cage”) placed between the vertebrae and containing bone graft material to promote fusion.

During the anterior lumbar interbody fusion, the surgeon spreads the abdominal muscles and moves the intestines and blood vessels aside. The surgeon removes the damaged disc and inserts the cage, typically made of titanium or medical-grade plastic, into the disc space. The cage generally contains bone graft material to promote fusion and support healing.

The bone graft may come from the patient, usually from the hip, or from a donor. Screws or plates stabilize and secure the cage, and their placement may be done through the original incision. Vascular surgeons often assist spinal surgeons during an ALIF surgery to manage blood vessels involving the legs.
Following ALIF surgery, you will be moved to the recovery room.

Anterior Lumbar Interbody Infusion Recovery and Rehabilitation

Following anterior lumbar interbody fusion surgery, most patients stay in the hospital, but length of stay depends on the level of pain, mobility, overall health, and available support at home. Patients are encouraged to stand and walk on the first day after surgery, often with the help of a back brace.

Because back muscles and nerves are not cut during ALIF surgery, patients may recover more quickly than from other spinal procedures. However, healing takes time, and you must avoid heavy lifting, strenuous activity, and high-impact exercise for at least six weeks.

After ALIF surgery, your surgeon will prescribe pain medication, and your recovery plan will include physical therapy to help restore mobility, rebuild core strength, and support proper spinal alignment. Most patients can return to light, desk-based work within four to six weeks, while physically demanding jobs may require eight to twelve weeks or longer.

Why Choose Hoag Orthopedic Institute for ALIF?

There is a reason that Hoag Orthopedic Institute is one of the nation’s largest orthopedic care providers. Our track record in treating back pain and spine problems and the expertise of our doctors is second to none. Hoag Orthopedic Institute is nationally ranked as one of the top Orthopedic Hospitals by U.S. News & World Report in 2024-2025, and is high performing in spinal fusion.

At Hoag Orthopedic Institute, we offer personalized treatment plans for every patient. Schedule an appointment with a spinal specialist today to determine whether ALIF surgery is right for you.