PATIENT GUIDE TO ANTERIOR LUMBAR INTERBODY FUSION
Dr. Saris has recommended
a procedure called an anterior lumbar interbody
fusion. It has been determined that your back pain is
likely due to deterioration in the disk in your low back. The recommendation
is that this disk be removed and replaced with what is called a
It is important to prepare for this
procedure. On the morning before the surgery, you should
take a bottle of magnesium citrate that you can buy at most
grocery stores. During the entire day before the surgery, you should
not eat solid food. Your diet could consist of any liquids, and
foods such as Jello and clear soup. This will greatly assist the
first part of the operation that will be performed by a surgical
colleague of mine.
the day of the surgery, you will meet with my associate, who is
a general surgeon trained to do the first part of the operation.
He will review the procedure that you are about to undergo and the
benefits and risks associated with this. These include possible
complications involving the bowel, arteries, and veins overlying
the spine, and other abdominal structures near the front of the
spine. The large blood vessels that lead to the legs lie right in
front of the spine where the fusion is performed. In many cases,
the vessels must be moved aside to perform the surgery. In most
research studies of the procedure, injury to blood vessels occurred
in only 1% of the cases reviewed.
You will then receive an intravenous and go off to sleep. If we
are only removing the diseased disk, the procedure will take approximately
three hours. If we are to additionally place pedicle screws into
your back, it will take a longer period of time.
you are asleep, an incision will be made next to the umbilicus (belly
button) that is approximately 4 inches long. After the front of
the spine has been exposed, I will come in to perform my part of
I will likely make an
additional, very small (about an inch) incision about 6 inches from
your umbilicus (belly button) to remove a small amount of bone.
This will be used to aid in a fusion.
The damaged disk is removed.
It is then replaced with a device filled with your own bone called
a prosthesis. This is approximately the size of a half-dollar, and
contains both your own bone and additional materials designed to
enhance proper healing of that area. Some prostheses are made of
bone, and some from synthetic materials including metal. An example
of how one looks on a X-ray is shown below.
FOLLOWING THE SURGERY
The usual hospital stay is 2 days. If, for example, you have
your operation on Monday morning, you will generally go home on
Wednesday. The amount of pain is moderate, and similar to a pulled
stomach muscle. On returning home, your activity level will generally
BENEFITS AND RISKS
The desired benefit is either substantial reduction or elimination
of your pain. Our goal is to eliminate prescription painkillers,
and replacement with anti-inflammatory medications such as Celebrex
or Motrin. Our goal is a return to normal activity. In my experience,
and in the medical literature, the success rates vary tremendously.
While my goal is to achieve success 100% of the time, a more realistic
goal is 80% of the time.
This is a safe procedure.
I have performed this procedure for about 2 years, and have had
no serious complications. The main risk is during the first part
of the procedure in which the important structures in the abdomen
are removed from the front of the spine. As in any procedure from
appendectomies to open-heart surgery, deaths have been reported;
however, for this procedure this is well under 0.1% and in the hundreds
(if not over 1,000) in Rhode Island, I have not heard of a single
one. The risk of infection is approximately 2%.
The goal of the procedure
is to eliminate motion at the site of a diseased disk. This is done
with a fusion. In the picture above, you can see two "vertebral"
bones separated by the prosthesis. In time, the two bones and the
prosthesis become one large bone. That is called the "fusion."
The incidence of non-fusion is under 10%. However, if it were to
occur, we would consider placing pedicle screws into the spine at
a second procedure.
Please call the office
if there are any questions about this guide or about your procedure.
Stephen Saris M.D.