This is a topical issue raised by patients who want their back fixed. As you may know, Tiger Woods returned to win the US Masters competition in 2019, having left competitive golf in 2014 due to intractable back pain. Having had multiple operations on his knees, he then required a discectomy and a laminectomy for disc degeneration and nerve compression. With further difficulties in his back, Tiger had an Anterior Lumbar Interbody Fusion, or ALIF.
What is the ALIF Procedure?
The ALIF is a spinal procedure designed to fuse the vertebrae together, thus stopping painful movements at that level in the spine. Having previously had discectomy and laminectomy which preserve motion at that disc level, Tiger reportedly had this procedure performed at L5S1, the most common level to have the procedure. The complaints that patients typically have, that ultimately require this surgery are low back pain and frequently leg pain. This affects a person’s quality of life, ability to work, leisure activities, sex life and frequently, one’s psychological health. The leg pain, if present, is from irritation of the sciatic nerve (sciatica) which typically causes pain to spread down the back of the leg, often starting in the buttock and can extend all the way to the toes. While the pain occurs mostly in one leg, this long standing degenerative condition such as Tiger’s, can cause pain to spread down both legs.
Who is a Candidate for ALIF Surgery?
Surgery is not for everybody and patient selection must be careful. Patients that have undergone this procedure are satisfied in over 85% of cases, with improvements in back pain, leg pain and quality of life scores improving by 40-50%.
Advantages and Risks of ALIF Surgery
The procedure involves an incision through the front of the lower abdomen, between the muscles and passing around the bowels. Major arteries and veins run past the disc level and often has to be gently slid away from the disc. The overall risk of a vessel injury and major bleeding is about 5% thus may involve the help of a vascular surgeon. Other risks include infection and persistence of back pain.
Recovery and Rehabilitation after ALIF Surgery
Improvements can continue for up to 18 months after the procedure. The advantages of this procedure are that the patient has less post-operative pain than the traditional fusion procedures through the back of the spine and so, they can leave the hospital sooner. They have better spinal fusion (bone knitting together) and the implant size is a much closer fit to that of the original disc height than what can be achieved from more traditional spinal fusion operations (through the back of the back). Most patients can resume short driving trips within 6 weeks and it takes 3-6 months to resume normal activities after this procedure. A key part of the outcome of any spinal surgery is the rehabilitation process which includes educating the patient about what to expect, building an awareness of post-operative precautions, increasing walking day-by-day and becoming independent with the exercise programme.
Written by Derek T Cawley