When fusion surgery is needed for the lower lumbar spine especially at L4-5 and L5-S1 level, it is best done through the anterior approach. In this surgery, the incision is on the belly and a bloodless tissue plane is developed to reach the lumbar spine. In this procedure surgeon chooses the access to lumber spine from the front (ALIF).
ALIF surgery can restore normal spine alignment and lumbar lordosis. This procedure is minimally invasive and does not damage any muscles or structures of the spine. It achieves indirect nerve decompression without even touching the nerves (extremely useful in revision or second-time spine surgery wherein the nerves are already scarred.)
In order to prevent nerve damage, electromyography or EMG is used for nerve monitoring, which provides surgeons the information about the the postion of nervs and surgical instruments durign the surgery.
The procedure is performed under general anasthesia. Using X-ray surgeon locates the disc and marks on the skin. An incision is made and instrument is passed to the spine and second incision is made for removing the herniated disc. On the side of vertebrae, tubular dialtors instruments are inserted through the muscles on the side of vertrae. Above them the tissue retractors are placed which has an opeing for light and instruments for accessing the disc space. The spinal disc is viewed and the disc is removed. An implant filled with bone graft for fusion is inserted into the hollow space of removed disc. Using X-ray the correctness of the postion of implant is ensured, retractors are removed and incisions are stitched and closed with dressing.