22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar

Name of the Procedure:

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar
Common Name(s): Anterior lumbar interbody fusion (ALIF)

Summary

Anterior lumbar interbody fusion (ALIF) is a surgical technique used to fuse two or more vertebrae in the lumbar spine from the front of the body. It involves removing a portion of the intervertebral disc and inserting bone graft material or a spacer to facilitate fusion of the spine segments.

Purpose

This procedure primarily addresses conditions causing chronic lower back pain and spinal instability. The main goals are to alleviate pain, restore spine stability, and improve the patient's mobility and overall quality of life.

Indications

• Chronic lower back pain not responsive to conservative treatments
• Degenerative disc disease
• Spondylolisthesis (slipped vertebra)
• Spinal instability or deformity
• Recurrent disc herniation

Preparation

• Patients may be instructed to fast for at least 8 hours before the procedure.
• Adjustments in current medications may be necessary.
• Preoperative imaging tests like MRI or CT scans to assess the affected area.
• Blood tests and a comprehensive medical history.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the lower abdomen to access the lumbar spine.
3. The surgeon carefully moves aside internal organs and blood vessels.
4. Part of the intervertebral disc is removed to prepare the interspace.
5. Bone graft material or a synthetic spacer is inserted between the vertebrae.
6. Metal plates, screws, or cages may be used to provide additional stability.
7. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 2-4 hours, depending on the complexity and number of levels fused.

Setting

The procedure is usually performed in a hospital operating room.

Personnel

• Orthopedic spine surgeon or neurosurgeon
• Anesthesiologist
• Surgical nurse(s)
• Surgical technologist
• Radiologist (if needed for intraoperative imaging)

Risks and Complications

• Infection
• Blood clots
• Nerve damage
• Blood vessel damage
• Failure of the vertebrae to fuse (nonunion)
• Pain at the graft site

Benefits

• Relief from chronic lower back pain
• Increased spinal stability
• Improved mobility and function
• Long-term solution for spinal degeneration and instability

Recovery

• Hospital stay of 2-5 days post-surgery.
• Pain management with medications.
• Guidelines on activity restrictions and gradual return to normal activities.
• Physical therapy may be recommended.
• Follow-up appointments to monitor healing and fusion process over several months.

Alternatives

• Conservative treatments like physical therapy, pain management, and lifestyle changes.
• Other surgical options such as posterior lumbar interbody fusion (PLIF) or lateral lumbar interbody fusion (LLIF).
• Pros of ALIF: direct access to the intervertebral disc, less disruption of back muscles.
• Cons: Higher risk of blood vessel and organ injury, longer recovery time compared to some other methods.

Patient Experience

• Experience general anesthesia, so no pain during the procedure.
• Possible post-operative pain managed with medications.
• Some discomfort and limited mobility during initial recovery.
• Gradual improvement as healing progresses.

Pain management techniques and supportive care will be provided to ensure post-procedure comfort.