(ALIF) Anterior Lumbar Interbody Fusion is a surgical procedure for patients with serious, long-term low back pain that have not been helped with non-operative programs. It involves adding bone graft to an area of the spine to setup a fusion where the bone grows between two vertebrae and limits the motion at that segment. Progressive developments have been made in spinal fusion techniques since its introduction in the early 1920′s. Approaches to the spine have been improved significantly as well. Transperitoneal exposures (approaching through the membrane lining the walls of the abdominal and pelvic cavities) have been replaced by Retroperitoneal exposures (approaching behind the peritoneum) – maintaining the integrity of the peritoneum and approaching the spinal column laterally. The advantage is less post-operative bowel problems for the patient. Radiographic studies; plain films, bone scan (SPECT), CT scan, MRI and discography are usually part of the evaluation process. Frequently more than one of these diagnostic studies is needed for an accurate diagnosis. ALIF may be utilized as an isolated procedure or in conjunction with posterior spinal fusion. The method with which ALIF is accomplished depends largely on the surgeon’s preference and experience. Minimally invasive techniques – open or laparoscopic – require greater intraoperative attention to detail and preoperative surgical planning.