ALIF is a type of spinal fusion surgery used to treat certain problems in the lower back, also called the lumbar spine. The goal is to relieve pain and stabilize the spine by permanently joining two or more bones (vertebrae) together.

What makes ALIF different from other spine surgeries is how the surgeon gets to your spine. The surgeon makes a small incision in your lower abdomen, this allows access to your spine without cutting through the large back muscles, which may lead to less pain and faster recovery.

We may recommend ALIF if:

• You have chronic lower back pain that hasn’t improved with medications, physical therapy, or rest.

• You’re diagnosed with degenerative disc disease, where the discs between your spine’s bones wear out over time.

• Your spine is unstable or misaligned, for example, if one vertebra is slipping forward (spondylolisthesis).

• You’ve had a herniated disc that continues to cause symptoms despite treatment

• You’ve already had spine surgery, and the pain has returned.

• You have a spinal deformity (like a curve in the spine) that needs to be corrected and stabilized.

This procedure is generally considered after conservative (non-surgical) treatments have not worked.

Here’s a step-by-step breakdown of what happens during the operation:

• Preparation: The patient will be under general anesthesia, which means you’ll be asleep and pain-free during the entire surgery.

• Accessing the Spine: The surgeon makes a small incision (usually 3–5 inches long) in your lower abdomen. The surgeon gently moves aside your abdominal muscles, intestines, and blood vessels to safely reach the front of your spine.

• Removing the Damaged Disc: The surgeon removes the damaged or diseased disc (the soft cushion between two bones in your spine) that’s causing pain or instability.

• Inserting the Spacer or Implant: In the empty disc space, the surgeon places a cage implant filled with bone graft material. This bone material can come from your own body, a donor, or be synthetic. The purpose is to help your vertebrae grow together over time.

• Stabilizing the Area: To keep the bones in place while they fuse, titanium screws are placed to stabilize the cage while the fusion takes place.

• Closing the Incision: Once everything is in place, the surgeon carefully closes the incision with sutures (stitches). You’ll be taken to a recovery area to wake up from anesthesia.

The following X-ray shows an L5-S1 anterior lumbar interbody fusion with a well-positioned interbody cage and fixation hardware. The implant is securely placed between the L5 and S1 vertebrae to maintain disc height and promote spinal stability. The alignment appears intact, with no obvious signs of hardware loosening, migration, or complications. This imaging helps assess the progress of fusion and overall spinal integrity post-surgery.

ALIF is a well-established procedure with several advantages:

Less damage to back muscles – since the surgery is done from the front, your back muscles remain untouched.

Larger implant size – allows for more stability and better alignment.

Improved pain relief – many patients experience a significant drop in pain after recovery.

Faster recovery in some cases – less disruption to muscle tissue can lead to quicker healing.

Better access to certain spinal areas – especially for treating problems at the lower levels of the spine (like L4-L5 or L5-S1).

As with any surgery, ALIF carries risks, although serious complications are rare. These include:

• Infection at the surgical site.

• Bleeding.

• Blood clots.

• Nerve injury, which could lead to numbness or weakness (though uncommon).

• Nonunion, where the bones do not fuse properly and may require further surgery.

• Damage to blood vessels or nearby organs during access.

• Retrograde ejaculation (in men) – a rare condition where semen flows backward into the bladder instead of exiting normally.

• Complications from anesthesia.

Your surgical team will explain these risks and take steps to minimize them.

Recovery is a gradual process, and every patient heals a bit differently. Here’s what you can generally expect:

• Hospital Stay: Most people stay in the hospital for 1–2 days. You’ll be monitored closely and encouraged to start moving with help.

• Pain Management: You’ll feel sore, especially in your lower belly, but pain medications will be provided to help you stay comfortable.

• Activity Restrictions: You’ll need to avoid bending, twisting, heavy lifting, or strenuous activity for several weeks. Your doctor will guide you on when it’s safe to increase your activity level.

• Physical Therapy: A rehabilitation program may be recommended to strengthen your back and core muscles, improve mobility, and speed up healing.

• Bone Healing (Fusion): It can take 3 to 6 months (or longer) for the bones to fully fuse. During this time, you’ll need regular follow-up appointments and imaging (like X-rays) to check progress.

• Returning to Work:

  • Desk or light-duty jobs: usually 4–6 weeks

  • Physically demanding jobs: may take 3 months or longer

Your return will depend on how well you're healing and the type of work you do.

• Stop smoking – it affects bone healing.

• Discuss your current medications with us.

• Arrange for help at home during the first few weeks.

• Follow all instructions regarding food, drink, and medications before surgery day.

If you’re thinking about ALIF or have been recommended the procedure, schedule a consultation with one of our experienced spine specialists. We’ll explain everything in detail, answer your questions, and help you feel fully informed and supported throughout your journey.