Anterior lumbar interbody fusion with percutaneous pedicle screw fixation is also known by its abbreviation terms ALIF with PPF. The spinal surgical procedure provides additional support and stability to the lumbar or lower region of the spine following removal or repair to one or more damaged vertebral discs in the spinal column. Screw fixation devices called pedicle screws also enhance the stability of the lower spine, which bear the weight of the body and promote mobility and range of motion in the hips.
ALIF fusion surgery has been performed for decades to help treat degenerative spine conditions and lower back pain. In the past two decades, this surgical procedure has been performed through the front of the body, or the anterior approach, rather than from the back or spinal column approach along the back. The anterior surface of the spine faces the front of the body. The anterior approach helps reduce the risk of damage to spinal cord nerves, vertebrae and discs.
This type of spinal surgery is often combined with anterior and posterior fusion approaches because additional fixation is required when stability of the spinal column is an issue. In the case where only one level or one vertebral disc is affected the ALIF procedure can be performed on its own. When more than one disk is damaged, or in the case where someone is diagnosed with isthmic spondylolisthesis, additional fixation through percutaneous or sub-tissue pedicle screw placement is recommended.
Anterior lumbar interbody fusion is performed with the patient starting in the supine position. General anesthesiology is offered, so the patient will be asleep during the procedure.
The spine is accessed through a moderate 3 to 5 inch incision made into the lower left quadrant of the abdomen. The spine is exposed and the damaged disk material is removed. To fill in the space, the surgeon will insert a bone graft or a device called an anterior interbody cage. The fixation device is screwed into place. Eventually, the bone will grow around the screws or device to offer greater stability to the lumbar or lower area of the spinal column.
The anterior interbody cage is generally made out of titanium, though technology now offers a variety of cages made of different materials and in different sizes and shapes. The cage device is placed in between the ends of the vertebra, which eventually bind to the bony end plates of the vertebrae by fixed screws threaded into the bone.
Fixation devices called pedicle screws are commonly used with the posterior or backside approach to spinal fusion to provide the greatest stability and support for the spine. Pedicle screws serve as an anchor for plates, rods or other fixation devices. The screws are placed over the surface of several vertebrae to provide stability and support, though they do limit mobility in the section of the spine in which they're used, in this case a small portion of the lower spine.
However, this restriction of movement is only temporary. As the spinal bone grows over the bony graft, the pedicle screws can be removed, though they are often left in place unless they cause discomfort for the patient, which is rare.
Any procedures done to reduce pain and improve mobility in patients are a benefit. Undergoing a spinal fusion might decrease pain in the back and legs, as well as reduce spine curvatures like scoliosis. Spinal fusion procedures are often recommended to those who suffer from severe back pain due to slippage of bones, causing misalignment.
The ALIF surgical procedure will be performed by an orthopedic surgeon or specialist and a vascular surgeon, due to the number of blood vessels and arteries in the lumbar region of the spine. When deciding on an orthopedic or spine fusion procedure, it is important to find an experienced and qualified professional who has experience with different techniques for spinal fusion procedures. Be sure to check the facilities before settling on a surgeon, and make sure that they are accredited, and that surgeons and their staff are trained, experienced and certified in their field.
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