Anterior and Posterior Lumbar Fusion Surgery

One type of lumbar spinal fusion is to have anterior and posterior surgery, which means that the surgery is done in both the front of the spine and the back of the spine.

This anterior/posterior lumbar fusion is usually done for patients with:

• A high degree of spinal instability, such as instability caused by conditions such as a fracture or spondylolisthesis
• Revision surgery if the initial fusion did heal together into a solid bone (pseudoarthrosis)
• Patients with flatback deformity (not enough curvature or lordosis) in the lumbar spine
• Severe foraminal stenosis (narrowing of the small windows or channels where the nerves exit on each side)

Another term used for this type of surgery is a 360-degree fusion.

Anterior/Posterior Lumbar Fusion Surgery Advantages

1. Fusing both the front and back provides a high degree of stability for the spine and a large surface area for the bone fusion to occur.
2. Approaching both sides of the spine often allows for a more reduction for patients who have deformity in the lower back (e.g. isthmic spondylolisthesis).
3. Some spine surgeons feel that if stabilization is achieved both through an anterior and a posterior approach, patients can be mobilized earlier in the postoperative period. Studies have shown that fusing both sides of the spine in the lower back does lead to a very high fusion rate (greater than 95% of these cases will achieve a solid fusion).
4. The anterior (from the front) approach is usually performed first. By removing the disc material and cutting the anterior longitudinal ligament (which lays on the front of the disc space), the spinal segment is "released" and allows for a more complete reduction.
5. After the anterior and the posterior spinal implants are inserted, this segment is very strong and stable.

One analysis of 75 patients concluded that 360° fusion surgery is a “predictable and lasting treatment option to improve pain and function in properly selected patients with mechanical degenerative disc disease.”¹Jack E Zigler, Rick B Delamarter. Does 360° lumbar spinal fusion improve long-term clinical outcomes after failure of conservative treatment in patients with functionally disabling single-level degenerative lumbar disc disease? Results of 5-year follow-up in 75 postoperative patients. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4300966/.

Anterior-Posterior Lumbar Fusion Potential Issues and Considerations

There are several disadvantages and potential adverse effects of an anterior and posterior spinal fusion, including:

1. A main drawback of the procedure is that both an anterior incision in the abdomen and a posterior incision in the low back need to be done, requiring more recovery time and potentially more postoperative pain because it is a more extensive surgery.
2. There is potential for increased risks associated with this surgery due to the longer operative time, and potentially longer hospital stays.
3. The increased extent of the surgery may be a consideration for someone with other health conditions, such as diabetes.

Some spine surgeons prefer to achieve anterior and posterior stability through a PLIF procedure, although there are drawbacks to approaching the disc space through a posterior approach (please see PLIF surgery).

Spine surgeons with strong training and expertise in doing ALIF surgery generally prefer an anterior/posterior approach.

The bottom line is that this technique does provide for very high rates of spinal fusion, but the spine fusion surgery is quite extensive and carries the risks inherent in both approaches.