ALIF access surgeon · Dallas–Fort Worth

ALIF exposure, explained.

Anterior lumbar interbody fusion approaches the lower spine through the abdomen. Dr. Pineda works alongside your spine surgeon to create that route, protect the surrounding anatomy, and manage the exposure through closure.

Understand the access surgeon’s role For surgeons: request coverage

The anterior approach

What is ALIF?

ALIF stands for anterior lumbar interbody fusion. “Anterior” describes reaching the lumbar spine from the front of the body. The spine surgeon removes the affected disc and places an interbody implant and bone graft to support fusion between the adjacent vertebrae.

The approach passes near abdominal contents and major blood vessels. An access surgeon manages those structures so the spine surgeon can work at the disc space. Your spine surgeon determines whether ALIF is appropriate and which levels need treatment.

Gerson O. Pineda, MD, FACS is a board-certified general surgeon whose practice is dedicated to anterior and lateral spinal access in Dallas–Fort Worth.

Meet Dr. Pineda

From planning to closure

What the access surgeon does during ALIF

  1. Plan the surgical corridor

    The team reviews the intended spinal levels, prior abdominal or anterior spine operations, relevant imaging, and anatomy that may affect the approach.

  2. Expose the disc space and protect the anatomy

    Dr. Pineda develops the retroperitoneal corridor, identifies and moves the peritoneal contents and ureter, and mobilizes the vessels over the spine to expose the planned disc space.

  3. Manage the exposure through reconstruction and closure

    While the spine surgeon completes the disc work and fusion, Dr. Pineda continues protecting the mobilized structures and adjusting the corridor as needed. He then completes closure of the approach.

The level changes the approach

Exposure at L5-S1 and L4-5

Blood vessels lie close to the lumbar disc spaces. The relationship between the vessels and the disc differs at L5-S1 and L4-5, so the exposure is planned for the specific level and the patient’s anatomy.

Previous operations, scar tissue, vascular anatomy, and the number of levels being treated can change how the corridor is developed. The access surgeon and spine surgeon review these factors together.

See Dr. Pineda’s cumulative spinal access experience

An informed discussion

What risks relate to the exposure?

Approach-related risks include bleeding or vascular injury, blood clots, bowel or ureter injury, temporary slowing of bowel function, wound infection, incisional hernia, fluid or lymphatic leak, and nerve injury. Some lower lumbar approaches can also cause retrograde ejaculation in men.

Your spine surgeon will explain the risks of the spinal reconstruction itself. Individual risk depends on the planned procedure, anatomy, previous operations, and overall health. Your surgical team’s consent discussion should address your own case.

Read the overview of risks and complications

Patient questions

Understanding your surgical team

Is the access surgeon the same as the spine surgeon?

They have different roles in the operation. Dr. Pineda manages the route to the spine and the surrounding anatomy. Your spine surgeon treats the spinal condition through that corridor.

Does every ALIF require a separate access surgeon?

No. The surgical team decides whether a separate access surgeon is appropriate based on the planned procedure, anatomy, patient history, facility, and surgeon judgment.

Who gives me preparation and recovery instructions?

Follow the instructions from your treating surgical team about medicines, eating and drinking, arrival, activity, and recovery. Ask the team about any conflicting or unclear instructions.

How is Dr. Pineda’s participation arranged?

Your spine surgeon’s office generally coordinates access-surgeon participation. Spine surgeons and coordinators can review coverage information or call the practice at 214-269-5353.

Further reading

Patient education and practice information

Page updated October 5, 2026.