This surgical video demonstrates the technique of an anterior lumbar interbody fusion (ALIF). This video demonstrates the surgical approach, technical nuances of ALIF, and pearls. The main surgical anatomy and approach-related risks are discussed. The video demonstrates the nuances of ALIF, discussing the importance of the release of the disc space to allow for height restoration and lordosis, endplate preparation to enhance arthrodesis, and choice of implant size. The incision is made via a left paramedian approach with a retroperitoneal dissection and mobilization of the vasculature for access to the disc space. The ALIF provides direct access to the ventral surface of the exposed disc, allowing for an incision of the anterior longitudinal ligament, bilateral release of the annulus fibrosus, and access to a large surface area of the vertebral endplate. This anterior access allows for the placement of implants with a greater surface area for fusion, and this facilitates restoration of segmental lordosis, disc height improvement, and foraminal height increase. We have received informed consent from this patient for the video of this case.