ALIFs can be done safely without posterior fixation in the case of an isthmic spondylolisthesis without significant nerve root pain (leg pain). The question is fusion rate as well as complication rate for an anterior approach. I believe it is acceptable but less successful than a posterior TLIF fusion where there is both anterior and posterior fixation as well as fusion on both sides.
If you are having a “360”, this would not be called an ALIF. A 360 would be an anterior and posterior fusion (an approach from the front and the back). In my opinion, this is unnecessary unless the slip is very large (grade III or larger).
I retract nerve roots all the time without damage or injury. It has to be done gently with proper technique by an assistant who is well trained. Interestingly, the decompression of the “Gill fragment” (the disconnected lamina and inferior facets) generally does not require nerve retraction. The nerves have to be uncovered as there typically are large spurs growing out of the inferior pedicles which compresses the nerves. An osteotome (like a chisel) is used to clear these roots.
The TLIF cage is sized just like the ALIF cage, with a “trial” of different sizes. The trials come in one millimeter increments for a good fit.
A stand alone ALIF will work but as I said before, a TLIF is better for stability success rate and healing.
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.