Spine surgery today is a lot different from the spine surgery of yesterday. Today, many spine surgeons use minimally invasive techniques as an alternative to open spine surgery. With minimally invasive spine surgery, you'll have a smaller scar, spend less time in the hospital, and quickly return to your daily activities. A technique called mini-open anterior lumbar interbody fusion (ALIF) accomplishes these goals for certain spine conditions.

This technique is done from your front; anterior means front. The advantages of this technique over a posterior (back) approach (eg, posterior lumbar interbody fusion) or a lateral (side) approach (lateral lumbar interbody fusion) are:

• your surgeon doesn't have to cut through your back muscles
• it's easier to insert a larger implant from the front of your body
• your surgeon direct access to your entire disc because he or she has access to the front of your spine
• there is more surface area, which allows for better fusion
• your nerve structures are not manipulated (moved) during the procedure

When Is Mini-open ALIF Used?
Mini-open ALIF is often used to fuse L5-S1. (The last vertebra in your lumbar spine—your low back—is fused with the first vertebra in your sacrum). However, it can also be used at higher levels in your spine. But because your low back supports a lot of your body weight, it's a common source of pain and, therefore, a common place to have surgery.

The goals of mini-open ALIF are:

• to relieve pressure on your spinal cord and/or nerve roots
• to stabilize your spine

This procedure is often performed in people who have:

• degenerative disc disease
• low-grade spondylolisthesis
• spinal stenosis

How Mini-open ALIF Is Done
For this procedure, you'll be lying on your back, and you'll most likely be under general anesthesia. Intraoperative imaging (eg, fluoroscopy) will also be used to help guide your surgeon.

Your surgeon will make one horizontal or vertical incision in your low abdomen, just above one of your pelvic bones. This incision is usually less than 5 cm. Sometimes a general, vascular, or thoracic surgeon will make this incision.

Although there are a few different approaches for mini-open ALIF, the easiest and most common approach is when your surgeon retracts your rectus abdominis—the abdominal muscle that runs vertically in the center of your stomach. He or she will also retract your peritoneum (a sac that holds your intestines and abdominal organs) using a retractor.

Then your surgeon will perform a discectomy; he or she will remove your disc.

With your disc gone, there's an empty space that will need to be filled. If it's not filled, your spine can become unstable, which means you can be more prone to excessive movement and perhaps injury. Therefore, your surgeon uses fusion to stabilize your spine.

He or she fills this empty space with a small cage that's shaped like a hollow cylinder. This cage is typically made with a plastic polymer, bone, or titanium, and it will be filled with bone graft, a substance that facilitates fusion between your vertebrae.

Bone graft can be created with real bone or a biologic substance. When it's from your own body, it's called autograft; when it's from a donor's body, it's allograft. Biologic substances (eg, bone morphogenetic protein)—man-made bone graft substitutes—can also help facilitate fusion.

This procedure is usually enough to stabilize your spine, but you might need more support. If that's the case, your surgeon may use rods and screws to help stabilize your spine as your bones fuse to form permanent support. Fusion typically takes 6 to 9 months.

Mini-open ALIF takes 1 to 2 hours to perform.

Mini-open ALIF Risks
Although mini-open ALIF has fewer risks than open spine surgeries, it's still spine surgery. Some of the risks for this procedure are:

• retrograde ejaculation: This is a disorder that happens when semen goes up into a man's bladder during ejaculation—a major risk factor for men who want to have children.
• injury to your bowel or bladder
• injury to your aorta (a main artery that runs along the front of your spine and splits before it gets to your legs)
• injury to your veins and other blood vessels
• blood clots
• bone graft may not properly fuse, which may require an additional surgery
• screws or rods (if used) may shift

Mini-open ALIF Recovery
Your doctor will let you know when you're ready to return to your regular activities, but most patients who have mini-open ALIF can return to their normal lives within a few weeks after surgery.