Surgery time for an ALIF in a thin patient is about two hours. For a muscular patient or heavier belly, add about an hour to that.
The fusion rate for a stand alone ALIF in the case of isthmic spondylolisthesis is about 85 to 90% using meticulous technique. If you don’t fuse, a posterior fusion is called for- the “minimally invasive pedicle screws” which they are not minimally invasive by the way.
The use of BMP with a stand alone ALIF cage should be standard as you need a fast fusion with an ALIF to prevent instability.
The papers regarding retrograde ejaculation with anterior BMP usage notes an increased risk. Since I rarely use an ALIF with BMP, I cannot comment on increased risk-just point to the papers that have been written about this subject. A good access surgeon will reduce the risk of muscular wall hernia or diastasis as well as small bowel obstruction but those risks are still present.
When they say “minimally invasive” from the front, that is not accurate. “Cutting muscle and bone” is what happens with an anterior approach, and their claim that it is deleterious from the back is not accurate. These small muscles that cross from segment to segment (multiifiti and transversals) are just that, small segmental muscles that are not needed when a fusion of the segment is planned. Moving these muscles (they are not removed) is necessary to get to their insertion site to allow bone formation to cross from L5 to S1.
The ALIF is not a bad operation but it does not address the typical pedicle spurs that grow off the inferior pedicle of L5 where the fracture initially occurred. If those spurs are not removed, many patients will have continued leg pain. You can with a second operation at a later point go into the back and remove these spurs but the point of this is to try and get only one operation to complete all the tasks at hand.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.