Occasionally doctors recommend anterior lumbar back fusion (ALIF) to get the best results for workers compensation employees with herniated discs represented by [nap_names id=”FIRM-NAME-1″] attorneys. In this procedure, the surgeon works from the front (anterior), removing a lumbar spinal disc (discectomy), inserting a bone graft between the two vertebrae to grow together into one solid bone (known as fusion). The long ligaments that run up and down the spinal canal are pulled taut. Most surgeons apply some form of metal hardware, so it can heal better and faster.
The anterior or ALIF approach has the advantage that, unlike the posterior or PLIF, both the back muscles and nerves remain largely undisturbed. Another advantage is that placing the bone graft in the front of the spine places it in compression, and bones in compression tends to fuse better.
Anterior lumbar fusion or arthrodesis is often used to help workers with symptoms from lumbar disc disease. Discs degenerate, or wear out, as a natural part of aging and also from stress and strain on the back due to job duties over time. Repetitive bending, twisting, turning and lifting job duties over time, wears out the disc, which begins to collapse, and the space decreases between the vertebrae. When this happens, the openings around the spinal nerves (the neural foramina) narrow and may put pressure on the nerves. The long ligaments in the spine slacken due to the collapse in vertebral height. These ligaments may buckle and put pressure on the spinal nerves. Also, the outer rings of the disc, the annulus, weaken and develop small cracks. Tears in the outer annulus are painful because these tissues are rich with pain sensors. The nucleus in the center of the disc may press on the weakened annulus and actually squeeze out of the annulus (herniate). Inflammation from the nucleus as it escapes the annulus also causes pain. The nucleus normally does not come in contact with the body’s blood supply. However, a tear in the annulus puts the nucleus at risk for contacting this blood supply. When the nucleus herniates into the torn annulus, the nucleus and blood supply meet, causing a reaction of the chemicals inside the nucleus. This produces inflammation and pain.
If the fusion is successful, the vertebrae that are fused together no longer move against one another. Instead, they move together as one unit. This helps relieve the mechanical pain, which occurs in the moving parts of the back. Fusion also prevents additional wear and tear on the spinal segment that was fused. By fusing the bones together, surgeons hope to reduce future problems at the spinal segment.