Anterior lumbar interbody fusion (ALIF) has become a widely recognized surgical technique for degenerative pathology of the lumbar spine. Spinal fusion has evolved dramatically ever since the first successful internal fixation by Hadra in 1891 who used a posterior approach to wire adjacent cervical vertebrae in the treatment of fracture-dislocation. Advancements were made to reduce morbidity including bone grafting substitutes, metallic hardware instrumentation and improved surgical technique. The controversy regarding which surgical approach is best for treating various pathologies of the lumbar spine still exists. Despite being an established treatment modality, current indications of ALIF are yet to be clearly defined in the literature. This article discusses the current literature on indications on ALIF surgery.

ALIF is an effective treatment for degenerative disk disease (with and without radiculopathy) and spondylolisthesis. Although results were promising for scoliosis, failed posterior fusion, and adjacent segment disease, further studies are necessary to establish the effectiveness of ALIF in these conditions.

Spontaneous rupture of the urinary bladder (SRUB) is uncommon and associated with significant morbidity and mortality. We report an unusual presentation of idiopathic, spontaneous bladder rupture with normal ascitic fluid creatinine concentration. SRUB should be considered in patients with a rise in serum creatinine and intraperitoneal free fluid even in the absence of classical features of bladder rupture. Idiopathic intraperitoneal SRUB can be conservatively managed in carefully selected patients with close follow up.

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