A new technique for lumbar fusion surgery incorporates threaded interbody cages. In contrast to its posterior counterpart, the anterior approach to this surgery appears to result in better fusion, less morbidity and quicker operations. This article reviews spinal anatomy and fusion and discusses the indications for anterior lumbar interbody fusion. The radiographer's role in diagnostic imaging, surgery and post-operative routines is chronicled. Radiation dose considerations are addressed and suggestions for improving follow-up assessment are offered.