Anterior Lumbar Interbody Fusion (ALIF)

Anterior lumbar interbody fusion (ALIF) is an established surgical technique for the treatment of degenerative lumbar spine disorders, including spondylolisthesis, disc degeneration, foraminal stenosis, and sagittal imbalance. By accessing the lumbar spine through a retroperitoneal anterior approach, ALIF allows direct disc space preparation, restoration of disc height, indirect neural decompression, and improved sagittal alignment while preserving posterior musculature. The procedure enables placement of large interbody cages with high fusion potential and facilitates correction of lumbar lordosis and spinopelvic parameters. Recent advances in implant technology, biologics, and minimally invasive techniques have expanded the indications and safety profile of ALIF. However, careful patient selection and understanding of vascular, neurologic, and approach-related complications remain essential. This chapter reviews the indications, surgical anatomy, operative techniques, radiographic considerations, clinical outcomes, complications, and evolving role of ALIF in modern spine surgery.