Mark Palumbo Endowed Chief of Spine Surgery, Brown University. Director, The Miriam Hospital Spine Program
At Brown Orthopedics Spine we have 2 guiding principles for spine deformity cases: 1) Plan your surgery carefully, then critically assess the success of your surgery to determine if the plan was achieved. 2) Fuse as few spinal levels as possible. This case shows why L5/S1 ALIF helps achieve surgical alignment plans, and also shorten constructs. Traditional posterior fusion may require the surgeon to fuse above and below the curve to straighten it: L5/S1 ALIF levels the foundation of the spine allowing us to straighten it from the bottom up. ALIF also is a very reliable method to get the exact lordosis from your plan. Once the foundation is leveled by ALIF, we can often fuse shorter. This 62yo patient achieved surprisingly good correction with only 4 levels fused due to careful planning and the power of ALIF. Miriam Hospital University Orthopedics International Spine Study Group (ISSG) Bassel George Diebo, MD Eren O. Kuris MD Bryce Basques, MD Chris McDonald, MD Alan Job, MD Sarah Criddle Mohammad Daher Joseph Nassar Andrew X. Christy C. Ciesla PT, DPT, PRPC, MBA Krista Acciaioli Spinal Alignment Solutions (SAS) Medtronic Cranial and Spine Therapies Alphatec Spine Carlsmed SMAIO Medacta International
Yann SABAH
1mo
L1L2 disc looks a bit degenerative on the preop Don’t you think / fear it might get worse after a while if just above a long fusion? Although T12 L1 does not look way better Also why no S1 screw in the ALIF cage?
Ralph Mobbs
1mo
L5/S1 ALIF is a gift from the Spine Gods….….as Tom Cruise says “L5/S1 ALIF….there is no substitute”
Cindy Hook
1mo
Alan, this is a fantastic example of the precision and innovation in spine surgery. The strategic use of L5/S1 ALIF to achieve optimal alignment with minimal fusion is truly impressive. Kudos to you and your team for such meticulous planning and execution!
Bravo! Learning from you that in surgical intervention patient post-op biomechanics must be given considerable foresight because with extensive fusion something as simple as sitting down or tying their shoes will become the patient’s Mount Everest.
Excellent concept 👏🏻
Great examples! I couldn't agree more. Thanks for sharing.
Orthopaedic Spine Surgeon at University Spine Center
1moNice! Why do sacroiliac fixation if you have an ALIF cage at L5-S1? Iliac fixation seems to decrease S1 strain more than ALIF in biomechanical studies but just wondering how you decide when to supplement the cage. Thanks!