Anterior Lumbar Interbody Fusion

Historical Background Anterior lumbar interbody fusion (ALIF) was first used AQ1 in the treatment of tuberculosis and lumbar spondylolis-thesis. 1−3 Although described by Capener 4 in 1932 as the " ideal'' operation for spondylolisthesis, he further elaborated that " the technical difficulties of such procedure, however, preclude their trial.'' This statement was soon to be proven wrong by numerous technical advances in ALIF. When initially developed, the transperitoneal approach for lumbar arthrodesis was the norm, but was later replaced by the retroperitoneal approach. The first description of the transperitoneal approach was published in 1906 by Muller, 5 and Iwahara 6 first reported the later approach in 1944. Further broadening the scope of ALIF, Lane and Moore 7 in 1948 reported ALIF as a treatment for lumbar degenerative disk disease. Here they used the transperi-toneal approach with an allogenic bone graft in 97 patients, reporting a 54% fusion rate after 8 months and a clinical success rate of 94%. Further developing Iwahara's retroperitoneal approach, Hodgson and Stock 8,9 established the foundation for the modern era of ALIF while treating Pott's disease with different bone grafting materials. Debridement of the necrotic tissue, followed by decompression of the spinal canal, allowed them to place corticocancellous blocks of auto-genous bone into the defect to obtain arthrodesis. The dowel technique, developed by Ralph Cloward in 1953, involved the use of cylindrical shaped corticocancellous dowels. Although Cloward 10−12 used a posterior approach, his methods for disk removal, end-plate preparation, and grafting were widely used. Following Cloward's dowel technique, four individuals adapted this to make their own innovations in bone grafting methods. Two of them, Harmon 13 in 1963 and Sacks 14 in 1965, were the first to utilize the dowel technique for an anterior lumbar fusion. The third, Crock, developed a cylindrical allograft for the anterior approach to the lumbar spine. Finally, the fourth, O'Brien et al, 15 modified a technique of using trapezoidal bone blocks for the treatment of lumbar discogenic pain through ALIF. They later developed a hybrid interbody graft using a biologic fusion cage (femoral cortical allograft ring) packed with autogenous cancel-lous bone graft. By using autogenous iliac crest bone graft, rapid incorporation and vascularization of the graft are achieved, as well as and long-term stability. 16 Furthermore , the femoral allograft ring allows for acute stability of the construct and a compatible framework for host bone ingrowth. 15 Despite the success in …