Common Conditions Treated with ALIF 

For spinal surgeons who prefer minimally invasive methods, the ALIF procedure represents a targeted surgical solution for specific spinal conditions that cause chronic pain and impaired mobility. It’s typically recommended when structural problems in the lower spine are confirmed through imaging and have not responded well to alternative, non-surgical approaches.

Spinal conditions commonly treated with ALIF include:

• Degenerative disc disease: Spinal discs lose their height and cushioning over time, making them not candidates for artificial disc replacement.
• Herniated disc: Displaced discs press on nearby spinal nerves, making them not candidates for artificial disc
• Spondylosis: Age-related spinal arthritis that contributes to stiffness and irritation, not a candidate for artificial disc
• Spondylolisthesis: One vertebra slipping forward over another, creating instability
• Degenerative scoliosis: Sideways curvature of the spine due to disc and joint degeneration
  

The optimal candidates for ALIF surgery are typically individuals with disc collapse and arthritic facet joints who are not candidates for artificial disc replacment at the lowest levels of the spine — specifically L4-L5 or L5-S1 — where restoring disc height can significantly reduce pain. While ALIF can be performed at higher levels, it’s technically more complex and may carry greater risks. Patients with a history of major abdominal surgeries or obesity may not be ideal candidates due to the surgical access required through the abdomen.

The ALIF Surgical Procedure Explained

Anterior lumbar interbody fusion surgery is performed in two key stages by a collaborative surgical team that includes a vascular surgeon and a spinal surgeon. In the first stage, the vascular surgeon creates access to the lower spine by making a small incision in the abdomen, either horizontally or vertically. The abdominal muscles are gently separated, and the internal organs are moved aside. This exposes the front of the lumbar vertebrae and lets the surgeon shield major blood vessels using special retractors.

The second part of the procedure is done by a spinal surgeon, like Dr. Hooman Melamed, who removes the damaged spinal disc and prepares the space between the vertebrae. A specially designed spacer — often referred to as a “cage” — is inserted to restore disc height and promote fusion. The cage may be filled with bone graft material to support long-term healing and stability. In some cases, screws are placed through the cage for added support.  An off-label use of FDA-approved BMP is used in almost all these cases.

If more support is needed, the surgical team may reposition the patient to place additional screws and rods from the back (posterior). The entire procedure typically lasts between 1 and 2 hours. On average, the total time under anesthesia is about 100 minutes, making it a relatively efficient surgery for complex lumbar spine conditions. However, this can vary depending on the patient’s anatomy, the presence of any spinal deformities, and whether they have had any prior spinal surgeries.

Equipment Used in ALIF Surgery

Specialized tools and devices are used during ALIF surgery to ensure safety and precision. A retractor is used to gently hold muscles, organs, and blood vessels out of the way, giving surgeons a clear and unobstructed view of the spine. During the fusion part of the surgery, a spacer or “cage” is placed between the vertebrae to restore disc height. This is a small impact that’s often filled with bone graft.

Live X-ray imaging, called fluoroscopy, helps guide the placement of implants with real-time accuracy. A Foley catheter is used temporarily to keep the bladder empty during surgery, which improves safety and patient comfort. Together, this equipment supports a minimally invasive, well-controlled procedure tailored to each patient’s unique spinal anatomy.

Recovery and Rehabilitation After ALIF Surgery

Thanks to its muscle-sparing approach, recovery from an ALIF procedure is often smoother than traditional spinal surgeries. Many patients are up and walking within the same day, and a significant number are able to return home shortly after. In fact, one study found that only 29% of ALIF patients required short-term aftercare, while the rest were able to be discharged directly home. The same study reported that only 1 out of 51 patients required further hospitalization for pain management, comprising a 2% unplanned admission rate.  Over 90% of Dr. Melamed’s patients are being discharged home the same day or the next day, and no need for any rehab.

Most patients experience a gradual improvement in pain and mobility over the first few weeks. While mild abdominal soreness is common at first, it typically resolves quickly. A structured rehabilitation plan — including light activity, guided physical therapy, and careful movement — helps support long-term healing.

Because ALIF is minimally invasive, complications are rare. In the same study mentioned above, no surgical site infections, serious complications, or deaths were reported in the 30-day  postoperative period. Additionally, the average blood loss was just 23 mL, which is significantly lower than other types of spinal surgeries.

Patients should be aware that ALIF surgery recovery time can take 6 to 12 weeks, depending on the individual’s overall health and whether additional hardware (like posterior rods or screws) was placed during the ALIF procedure. Dr. Melamed and his surgery team provide comprehensive and personalized post-operative care to ensure each patient returns to daily life safely and confidently.   Almost 95% of patients are ready to start PT after 6 weeks, after the X-rays confirm the progressive healing

Make an Appointment with Dr. Melamed Today

If you’re struggling with chronic back or leg pain that hasn’t improved with non-surgical care, ALIF surgery may be the solution you need. As a board-certified spine surgeon in Beverly Hills, Dr. Hooman Melamed offers expert, minimally invasive care tailored to each patient’s needs. Request an appointment online today to schedule a consultation and explore whether ALIF is the right path forward for you.