Michael Thomas D.O.

University of Miami

Spine Fellow

-SINCE 1960 –MULTIPLE ALIF MODIFICATIONS

-HISTORY OF CONTROVERSY OF STAND ALONE IMPLANTS

-GROWING RECENT TRENDS TOWARD STAND ALONE

ALIF EARLY EXPERIENCE AND OUT

COMES OF STAND ALONE ALIF

DEVICES

STEVEN VANNI D.O.

SR. AUTHOR AND NEUROSURGEON

OUR

DR CLOWARD FIRST PERFORMED ALIF SURGERY IN 1950s

FOR LOW BACK PAIN AND DDD

WAS NOT WIDELY ACCEPTED BECAUSE OF 30-40% NON

UNION RATES

IN THE 1990s THERE WAS A RESURGENCE OF

ALIF’s BECAUSE OF THE ADVENT OF NEW THREADED

TITANIUM CAGES THAT HELD THE DISK SPACE BETTER

AND ALLOWED FOR HIGHER FUSION RATES

(RAY THREADED CAGE, BAKER THREADED CAGE AND

CARBON FIBER CAGES)

CURRENTLY FUSION RATES ARE AS HIGH AS 95% WITH

THE NEW ALIF TECHNOLOGY

THE ALIF DEVICE IS DESIGNED AND UTILIZED

FOR ANTERIOR FIXATION AND FDA

APPROVED FOR 1 AND 2 LEVEL CONTIGUOUS

FUSIONS

RETROSPECTIVE CASE REVIEW OF 22 PATIENTS

ALL PATIENTS HAD ALIF PEEK CAGES W/ LOW PROFILE PLATE

AND CORTICAL SCREWS

REVIEWED CHARTS FOR NUMBER OF LEVELS

REVIEWED SUBSTRATE USED IN THE INTERBODY DEVICE

CATEGORIZED THE BODY MAS INDEX OF EACH PATIENT

FUSION WAS ACESSED BY THE PRIMARY SURGEON AND AN

INDEPENDENT RADIOLOGIST

FUSION CRITERIA INCLUDED TRABECULAR BONE FORMATION ON

XRAY’s/CT SCAN’s OF THE LUMBAR SPINE

THE PTS SMOKING STATUS WAS NOT CONSIDERED IN THIS STUDY

10 ALIF LEVELS WERE SUPPLEMEMTED WITH PEDICLE SCREWS (SOME OF

THESE PROCEDURES WERE PART OF LONG CONSTRUCTS FOR

DEFORMMITY CORRECTION)

MULTIPLE LEVEL ALIF’s W/ PEDICLE SCREWS =2 PATIENTS/4 LEVELS

MULTIPLE LEVEL STAND ALONE ALIF FUSIONS = 3 PTS/6 LEVELS

SINGLE LEVEL STAND ALONE ALIF’s =11

TOTAL STAND ALONE ALIF’S=17 LEVELS -

THE NON-UNION LEVEL ALREADY HAD PEDICLE SCREWS (REVISION

CASE)

FUSION RATE WAS 96.3 %

70 YEAR OLD FEMALE W/ 2 YEAR HX

OF

SEVERE BACK AND BILATERAL LEG

PAIN

PREVIOUS L3-4 LAMINECTOMY AND

FUSION

EXAM

LIMITED ROM W/ FLEXION AND

EXTENSION

ANTALGIC GAIT WITH DIFFICULTY

HEEL AND TOE WALKING

NEURO EXAM OTHERWISE NEGATIVE

60 YEAR OLD FEMALE

WITH RECENT HX OF MVA

C/O BACK PAIN 10/10

AND BILATERAL LEG PAIN

9/10

FAILED CONSERVATIVE

MANAGEMENT

EXAM

ANTALGIC GAIT AND

BILATERAL STRAIGHT LEG

RAISING TEST

NEUROLOGICAL EXAM

UNREMARKABLE

IT IS OUR EARLY EXPERIENCE THAT STAND ALONE ALIF

TECHNOLOGY WITH THE USE OF BMP IS A FEASIBLE

OPTION COMPARED TO TLIF AND PLIF PROCEDURES.

THE FUSIONS WERE QUITE ROBUST WITH MINIMAL

SUSIDENCE OF THE INTERBODY DEVICES.

THE DURATION OF SURGERY AND BLOOD LOSS

WAS CALCULATED TO BE MINIMAL

COMPARED TO THE POSTERIOR APPROCHES

MAINTAINANCE OF LORDOSIS AND SAGITAL

BALANCE IS TO PLIF OR TLIF

THE ONLY DEMERIT WAS AQUIRING AN ACCESS

SURGEON