Anterior Lumbar Interbody Fusion in the Treatment of Mechanical Low Back Pain

Indications for Anterior Lumbar Interbody Fusion

“…Retrograde ejaculation and sterility has been reported in many studies due to injury of the superior hypogastric sympathetic nerve plexus particularly when operating at L 4 /L 5 level. Vascular injury is more common when operating at L 4 /L 5 level due to the anatomy of the iliac vessels and iliolumbar vein. Spine specific complications include implant migration, graft collapse and expulsion and pseudoarthrosis.…”

“…Furthermore, according to Woolf's Law, fusion potential increases if grafts are placed under direct compression which supports placement of the graft in the anterior column. Additionally, the anterior and middle columns provide 90% of the osseous surface area containing more vas-cularity than the posterolateral space and this wide cancellous bed for graft contact enhances the fusion potential 13,31 . This also facilitates placing a larger interbody device that contacts the apophyseal ring and increases the segmental lordosis 13 .…”

“…Additionally, the anterior and middle columns provide 90% of the osseous surface area containing more vas-cularity than the posterolateral space and this wide cancellous bed for graft contact enhances the fusion potential 13,31 . This also facilitates placing a larger interbody device that contacts the apophyseal ring and increases the segmental lordosis 13 . While Chow et al found "no relation between bony fusion and symptomatic relief ", other studies show that there is generally correlation between successful fusion rate and good clinical outcomes 37 .…”

“…These complications can be considered as approach based or spine specific 58 . With the anterior approach, mobilization of the great blood vessels and peritoneal contents, and exposure of the superior hypogastric sympathetic plexus place them at risk of iatrogenic injury 13 . The literature reports a host of approach based complications but the most common are retrograde ejaculation, vascular injury, superficial infec-tion, urological injury and abdominal muscle damage 59,60 .…”

“…Since that time little progress was made with the ALIF technique until the 1980s. After 1980, several advancements were made to reduce morbidity including bone grafting substitutes, metallic hardware instrumentation, improved surgical technique and superior lighting and retraction 2,[11][12][13][14] . However, the controversy regarding which surgical approach is best for treating various pathologies of the lumbar spine still exists 3,[15][16][17][18][19] .…”