Anterior lumbar interbody fusion (ALIF) has significantly evolved since its initial descriptions in the early twentieth century. Originally performed using a transperitoneal approach, the shift to the retroperitoneal technique along with advancements in instrumentation has transformed ALIF into a commonly used procedure for treating various spinal pathologies. It is particularly effective for procedures at the L4-L5 and L5-S1 levels, addressing a wide range of conditions, including degenerative disorders, deformities, tumors, and infections. ALIF provides several benefits, such as minimal disruption of the posterior spinal column, indirect neural decompression, and effective restoration of disc height and lumbar lordosis. Indications range from degenerative disc disease and spondylolisthesis to trauma and tumors. However, careful patient selection is essential, as anatomical constraints, vascular health, and conditions such as osteoporosis can impose limitations. The surgical technique involves careful preoperative evaluation, strategic patient positioning, and precise dissection to access the lumbar spine while minimizing vascular and neurological risks. ALIF achieves high fusion rates (~94.5%), with debated considerations regarding stand-alone ALIF versus posterior fixation. While complications such as vascular injury, retrograde ejaculation, and ileus exist, meticulous surgical planning reduces risks. ALIF remains a highly effective fusion strategy, particularly for restoring lumbar lordosis, with evolving techniques refining its applications and outcomes.