Anterior Lumbar Interbody Fusion in the Treatment of Mechanical Low Back Pain

A number of options exist for patients with intractable back pain and degenerative disc disease (DDD). Interbody fusion techniques exploit the mechanical advantages of the disc space anteriorly, including a large fusion bed, excellent blood supply and graft compression. Unlike posterior approaches, the anterior, retroperitoneal technique affords wide access to the disc space without necessitating significant retraction on the lumbar extensor muscles. Instrumentation options are rapidly advancing, but remain more limited than posterior approaches. The failure rate of stand-alone anterior lumbar interbody fusion (ALIF) remains a concern and a variety of percutaneous or less invasive posterior approaches have been devised to augment ALIF procedures. This article examines the role of stand-alone and posteriorly stabilized ALIF in the management of DDD.