Why the Anterior approach to spine fusion?

The anterior approach allows the surgeon to have direct access to the degenerated disc without having to manipulate any nerve roots. Better correction of the collapsed disc to its native height can also be achieved by having a better leverage point to open the disc space. This can also help in restoring lordosis to the lumbar spine and to decrease fatigue of the surrounding posterior spinal muscles. No anterior or posterior muscle dissection is required to gain access to the front of the spine (unless the anterior approach is done in combination with a posterior approach for instrumentation).

Risks

As with all procedures, the anterior approach carries with it a few unique potential risks and complications that are not relevant to the posterior approaches. In addition, not all conditions can be successfully addressed with an anterior approach or ALIF, such as lumbar spinal stenosis, where a posterior decompression needs to be performed.

Indications

Common conditions that may be treated with an ALIF include lumbar degenerative disc disease and lumbar foraminal stenosis.  Common conditions that are not usually treated with an ALIF include any pathology that is mostly posterior (in the back of the spine), such as isthmic spondylolisthesis, degenerative spondylolisthesis or lumbar spinal stenosis. In cases where there is a lot of instability, such as isthmic spondylolisthesis, an ALIF may be combined with a posterior decompression fusion with instrumentation, which is called an anterior/posterior fusion. ALIF procedures are also contraindicated for anyone with thinning of the bones (osteopenic or osteoporosis). Generally, an ALIF spine surgery is inadvisable for patients older than 60-65 years.