Anterior Lumbar Interbody Fusion (ALIF)
CPT / Procedures
- 22558 (anterior arthrodesis L, +22585 each addl)
- 22845 (anterior instrumentation)
- 22853 (interbody device)
- 20930/20931 (graft).
Attire
Size 8 gloves — Biogel underneath + size 8 white gloves on top
Size XL gown ×3
Approach / team
Dedicated approach surgeon (vascular/general) performs the retroperitoneal exposure and abdominal closure.
Position & table
- Supine on OSI radiolucent flattop table. Arms are out to the sides on arm boards.
- Set the spine frame to the lowest hole/setting at the head, and the lowest hole setting at the foot
- If patient has high sacral slope, place a ‘bump’ (either gel roll or saline bag wrapped) under the sacrum
- Place foley
- Place O2 continuous pulse oximetry monitor on the left great toe
- Clip hair for skin preparation from umbilicus to 2 inches below pubic symphysis
- Place NuVasive retractor arm clamp on bed BEFORE neuromonitoring wires are placed.
- Place a clamp on the patient’s right side just distal to the arm board, and on the patient’s left side - place another clamp at the level of the patient’s greater trochanter.
- Upper body bair hugger
Prep, drape & cautery
| Item — exact product | Size | Vendor | Catalog # | Open | PRN |
|---|---|---|---|---|---|
| Positioning · warming · DVT prophylaxis (non-sterile, in room) | |||||
| Sequential compression device (SCD) pump | Cardinal / Kendall | SCD 700 | 1 | ||
| SCD compression sleeves (Vasopress), size to patient | M / L | Cardinal | VP501MG / VP501LG | 1 pr | |
| Forced-air warming blanket, upper body (Bair Hugger) + unit | 3M | 52200 | 1 | ||
| Foam positioning kit / arm pads / gel rolls | Xodus | SPK10113 | 1 | ||
| Surgical skin marker (black) + field marker (purple) | Viscot | 1450XL | 1 | ||
| Foley catheter + insertion tray, 16 Fr | 16 Fr | BD | 903016A | 1 | |
| Skin prep · antisepsis | |||||
| Chlorhexidine (Hibiclens) scrub brush | 1 | ||||
| ChloraPrep applicator — 2% CHG / 70% IPA, tinted | 26 mL | BD (CareFusion) | 930815 | 2 | |
| BD Surgiphor wound irrigation — 0.5% PVP-I | 450 mL | BD | 910110 | 1 | |
| Major basin pack (RSP) | Novo Health | 124514C | 1 | ||
| Mastisol liquid adhesive vial | 0.66 mL | Ferndale | 52348 | 1 | |
| Draping | |||||
| Blue OR towels (per pack) | 17×30 in | Medical Action | 7048 | 2 | |
| Steri-Drape impervious towel drape ('1010') | 23×35 in | 3M | 1010 | 4 | |
| Medline InvisiShield towel drape ON ROLL (prep stand) | 18×12 in | Medline | DYNJSD1000RL | 1 | |
| Medline Sterile Surgical Utility Drapes with Tape, 200 EA/CS | 38×66 cm | Medline | DYNJP2405 | 4 | 2 |
| Ioban 2 antimicrobial incise drape (iodophor) | 33×35 in | 3M | 6651EZ | 1 | |
| Spine custom pack (PPMC) | Medline | DYNJ69083 | 1 | ||
| Split-sheet drape | 77×120 in | Medline | DYNJP8304 | 1 | |
| 3/4 sheet drape | Medline | DYNJP2414 | 1 | ||
| Pocketed CV top drape — bilateral pouches | Medline | DYNJP4220 | 1 | ||
| Instrument pouch — adheres to drape | 10×11 in | Microtek / Medline | 8918 | 1 | |
| C-arm drape (PPMC Ecolab / CCH Tidi C-Armor) | 27×60 in | Ecolab / Tidi | 4951 / 5523 | 1 | |
| Leg-cover drape | 31×48 in | Medline | DYNJP2460 | 1 | |
| Skin stapler | 35 W | Covidien Appose | 8886803712 | 1 | |
| Sponges | |||||
| Raytec gauze sponge, 12-ply, X-ray detectable | 4×4 in | Cardinal Health | 6939 | 2 | |
| Laparotomy sponge (lap pad), 18×18, per pack | 18×18 in | Medline | MDS72038 | 3 | |
| Lap-tape sponge (long/thin), X-ray detectable — narrow channels / gutters | 4×18 in | Medline | MDS251504LF | 2 | |
| Cottonoid patty (neuro) | 0.5×0.5 in | Integra | 801400 | 1 | |
| Sharps · needles · syringes | |||||
| Surgeon's blade #10 / #15 | #10 / #15 | Aspen | 371110 / 371115 | 1 ea | |
| Surgeon's blade #11 | #11 | Aspen | 371211 | 1 | |
| Hypodermic needle 22G / 25G | BD | 305127 | 1 | ||
| IV catheter / angiocath 18G (local / irrigation) | 18G | BD | 381454 | 1 | |
| Luer-lock syringe 20 cc | BD | 302830 | 1 ea | ||
| Spinal needle — level localization 18G | BD | 405181 | 1 | ||
| Needle counter box, magnetic | 40-ct | Medline | NC40FBR | 1 | |
| Hemostasis | |||||
| Floseal (10 cc), bone wax | ✓ | ||||
| Recothrom + Thrombin 5000 units – uses on cottonoids | ✓ | ||||
| Cautery & suction | |||||
| ESU pencil + integrated holster | Valleylab / Bovie | E2515H / ESPH | 1 | ||
| Bovie tip scratch pad | Bovie | ESSP | 1 | ||
| Bipolar forceps cord + adaptor (Storz) + pedal | Storz | — | 1 | ||
| Grounding pad / return electrode (REM) | Medtronic | 7507 | 1 | ||
| Yankauer suction tip + Poole (anterior) | Sage | 006629 | 1 | ||
| Disposable plastic Frazier suction tips — 16Fr ×2, 12Fr ×2, 10Fr ×2 | 1 | ||||
| Neptune 2 Ultra suction unit + tubing + canister | Stryker | — | 1 | ||
| Closure · drains · dressing | |||||
| Abdominal wall / fascia closed with #1 Maxon (or PDS) – open x2 | ✓ | ||||
| Dermis closed with 3-0 Vicryl – open x2 | ✓ | ||||
| Skin 3-0 clear stratfix (of V-loc) | ✓ | ||||
| Dermabond. | ✓ | ||||
| none | ✓ | ||||
| Smith & Nephew [6⅛" × 3⅜"] OpSite dressing | ✓ | ||||
| Cautery settings: Bovie 35 / 35 cut-coag, Bipolar 35 · 1 bovie (open) + 1 additional bovie PRN (if co-surgeon) · 2 suctions off bottom of field · grounding pad on thigh. Meds (pharmacy): Local: bupivacaine 0.25% w/ epi; TXA (tranexamic acid): 30 mg/kg load + 1 mg/kg/hr infusion throughout the case; Antibiotic: 2g Ancef unless patient has an allergy | |||||
Imaging
C-arm, drape C-arm and use C-armor for lateral images
Neuromonitoring
MEPs, SSEPs, EMG
Sets & instruments
Open these sets — click for the full tray list
- Core: Spine Basic, Lumbar Spine Extras, Anterior Lumbar (ALIF/TDR)
- Retractor: ALIF retractor the implant company will bring. ie Nuvasive MaXcess ALIF retractor
- Curettes: Chroma-Line Curettes
- Kerrisons: Black Kerrisons (1–5 mm) or Life Spine Kerrisons
- Bipolar: Silverglide bayonet.
- Long clip appliers set (red, blue, green).
- Vascular tray: DeBakey/Satinsky, bulldogs, vessel loops; Doppler for vessel/iliac check.
Implants (loaner / rep-brought — confirm vendor at new site)
ALIF cage (integrated screws in cage): Trials, screw set, locking driver.
In addition to the implant, the vendor set provides the long pituitary rongeur, Kerrison, bayonetted scalped blade, long Cobb elevators, and long straight and angled curettes for the discectomy and disc prep.
Graft
INFUSE / BMP (on-label for ALIF) 2.05 mg packed in cage
Bony / power
Stryker Sumex Pi Drive 2+ aka TPS drill set (#1588-001 OR #1588-002) (primary) / MidasRex MR8 (alternative); high-speed burr + endplate prep instruments.
Vessel hemostasis adjuncts (have ready)
Vessel loops, papaverine, heparinized saline, topical thrombin, Floseal, Surgicel, Surgifoam.
Hemostasis
Floseal (10 cc), bone wax
Recothrom + Thrombin 5000 units – uses on cottonoids
Medications
- Local: bupivacaine 0.25% w/ epi.
- TXA (tranexamic acid): 30 mg/kg load + 1 mg/kg/hr infusion throughout the case.
- Antibiotic: 2g Ancef unless patient has an allergy
Drain
none
Closure
Abdominal wall / fascia closed with #1 Maxon (or PDS) – open x2
Dermis closed with 3-0 Vicryl – open x2
Skin 3-0 clear stratfix (of V-loc)
Dermabond.
Dressing
Smith & Nephew [6⅛" × 3⅜"] OpSite dressing