What Is Anterior Lumbar Fusion with Disc Replacement?

• In simple terms: One diseased disc is fused for stability, while another disc is replaced with an artificial disc to keep movement.
  
  

• Scientifically: The procedure combines anterior lumbar interbody fusion (ALIF) at one level with lumbar disc arthroplasty at an adjacent level via an anterior retroperitoneal approach, balancing arthrodesis with motion preservation to reduce adjacent segment degeneration.
  
  

Conditions Treated

• Multi-level degenerative disc disease (1 level requiring fusion, 1 level suitable for disc replacement)
  
  

• Disc collapse with instability at one level and discogenic pain at another
  
  

• Radiculopathy or nerve compression from multi-level disc disease
  
  

• Patients seeking motion preservation while requiring stability
  
  

Who Is a Candidate?

Good candidates:

• Younger, active patients with 2-level lumbar disease
  
  

• Healthy bone density, no severe arthritis
  
  

• Single level unstable (fusion required), adjacent level degenerative but stable (disc replacement possible)
  
  

Not candidates if:

• Severe multi-level instability
  
  

• Significant facet arthritis at disc replacement level
  
  

• Osteoporosis or poor bone quality
  
  

• Prior fusion at adjacent levels
  
  

The Hybrid Procedure: Step by Step

Plain-English Overview

1. Anesthesia & positioning: You’re asleep under general anesthesia, lying on your back.
   
   

2. Anterior approach: A small incision in the abdomen allows access to lumbar discs.
   
   

3. Disc removal: Diseased discs are removed at affected levels.
   
   

4. Fusion level: One disc space is fused with a cage and bone graft for stability.
   
   

5. Replacement level: An artificial disc is placed at the adjacent level to preserve motion.
   
   

6. Closure: Incision closed; most patients go home in 1–2 days.
   
   

Surgeon-Level Detail

• Exposure: Anterior retroperitoneal approach with vascular assistance.
  
  

• ALIF level: Complete discectomy; endplate preparation; interbody cage with autograft/allograft or BMP; anterior plating or integrated fixation as needed.
  
  

• Disc replacement level: Full discectomy; endplate milling; artificial disc sized and implanted under fluoroscopy.
  
  

• Final construct: One fused segment plus one mobile arthroplasty segment.
  
  

• Closure: Layered closure; drains rarely used.
  
  

Benefits of Hybrid Fusion with Disc Replacement

• Provides stability where needed (fusion)
  
  

• Preserves motion at adjacent level (disc replacement)
  
  

• Reduces risk of adjacent segment disease compared to 2-level fusion
  
  

• Relieves both back and leg pain
  
  

• Faster recovery compared to multi-level fusion
  
  

Risks & Limitations

• More complex than single-level surgery
  
  

• Risks of anterior approach: vascular injury, retrograde ejaculation (men), abdominal organ injury
  
  

• Implant wear/migration (rare with modern devices)
  
  

• Fusion non-union possible at fused level
  
  

• Long-term outcomes depend on careful patient selection
  
  

Recovery Timeline

• Hospital stay: 1–2 days for most patients
  
  

• Weeks 1–2: Walking encouraged; light daily activity resumed
  
  

• Weeks 2–6: Desk work possible; restrictions on lifting/twisting
  
  

• 6–12 weeks: Begin structured physical therapy; strength and flexibility restored
  
  

• 3–6 months: Resume most activities; fusion consolidating, artificial disc functional
  
  

• 6–12 months: Long-term imaging confirms fusion success and disc stability
  
  

Why Choose Desert Spine and Pain?

• Expert neurosurgeon: Dr. Greenwald specializes in complex hybrid lumbar surgeries
  
  

• Balanced approach: Fusion where stability is required, disc replacement where mobility matters
  
  

• Advanced implants: State-of-the-art cages and prostheses with proven durability
  
  

• Patient-focused care: Surgery only recommended when non-surgical options fail
  
  

Frequently Asked Questions

Why combine fusion with disc replacement?

Because some levels require permanent stability, while others can benefit from preserved motion. This balance provides pain relief and flexibility.

Is hybrid surgery better than 2-level fusion?

For the right patient, yes. Preserving motion at one level reduces stress on other discs compared to full fusion.

How long do artificial discs last?

Most are designed for 10–20+ years. Long-term data shows good durability.

How long does recovery take?

Most patients return to normal activities within 3–6 months, with full recovery by 12 months.

How does Desert Spine and Pain perform this differently?

We use neurosurgical precision, MIS techniques, and advanced implants, tailoring surgery to each patient’s anatomy and needs.