The modern application of anterior lumbar interbody fusion (ALIF): a narrative review of perioperative considerations and surgical pearls.

Background and Objective: Anterior lumbar interbody fusion (ALIF) has become a pivotal technique in managing chronic back pain, radiculopathy, neurogenic claudication, and spinal deformity. This review aims to compare ALIF with other fusion methods, highlight its advantages and disadvantages, and provide surgical insights to enhance perioperative outcomes. Methods: A comprehensive literature search was conducted using databases such as PubMed, Embase, and Cochrane Library, focusing on publications from the past two decades. Articles were selected based on relevance, study design, and the inclusion of key perioperative considerations and surgical techniques. Only English-language studies were considered. Key Content and Findings: This review examines the historical evolution of ALIF, its current clinical applications, and the development of associated surgical techniques. It discusses preoperative evaluations, imaging strategies, and patient selection criteria. Key findings highlight that ALIF offers superior disc height restoration and segmental lordosis compared to other fusion techniques. However, it presents unique challenges such as potential vascular and visceral injuries. The review also outlines critical surgical pearls for effective ALIF execution and strategies to mitigate common complications like subsidence and nerve root injuries. Conclusions: ALIF is a robust technique for lumbar spine pathology, providing significant benefits in appropriate patient populations. This review underscores the importance of meticulous surgical planning and technique to optimize outcomes. Future research should focus on long-term comparative studies and the development of enhanced surgical instruments and protocols. Implementing these insights into clinical practice may improve patient outcomes and influence surgical guidelines and policies.