ANTERIOR EXPOSURES FOR SPINE CASES

Anterior Approach / Exposure is performed by a Vascular Surgeon for an Anterior lumbar interbody fusion (ALIF), Corpectomy and Discectomy of the spine.  

Anterior lumbar interbody fusion (ALIF) is a spine surgery that involves approaching the spine from the front (anterior) of the body for the spine surgeon to remove all or part of a herniated disc from in between two adjacent vertebrae (interbody) in the lower back (lumbar spine), then fusing, or joining together, the vertebrae on either side of the remaining disc space using bone graft or bone graft substitute.  A corpectomy which is the removal of a vertebra body due to a tumor, collapsed or fractured disc.  Or a Discectomy is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. The procedure involves removing the central portion of an intervertebral disc, the nucleus pulposus, which causes pain by stressing the spinal cord or radiating nerves.

The anterior lumbar interbody fusion (ALIF) is similar to the posterior lumbar interbody fusion (PLIF), except that in the ALIF, the disc space is fused by approaching the spine through the abdomen instead of through the lower back. In the ALIF approach, a three-inch to five-inch incision is made on the left side of the abdomen and the abdominal muscles are retracted to the side.

Since the anterior abdominal muscle in the midline (rectus abdominis) runs vertically, it does not need to be cut and easily retracts to the side. The abdominal contents lay inside a large sac (peritoneum) that can also be retracted, thus allowing the spine surgeon access to the front of the spine without actually entering the abdomen.

Because of these large blood vessels (aortic and iliac vessels) that continue to the legs lay on top of the spine, so many spine surgeons will perform this surgery in conjunction with a vascular surgeon who mobilizes the large blood vessels. After the blood vessels have been moved aside, the disc material is removed, and bone graft, or bone graft and anterior interbody cages or Artificial Disc, is inserted.

Advantages of ALIF Surgery

The ALIF approach is advantageous in that, unlike the PLIF and posterolateral gutter approaches, both the back muscles and nerves remain undisturbed.  Another advantage is that placing the bone graft in the front of the spine places it in compression, and bone in compression tends to fuse better.  Lastly, a much larger implant can be inserted through an anterior approach, and this provides for better initial stability of the fusion construct.



Anterior Exposures for Spine Cases: Complications