Michael Rogers*, Ashish Patel, Van Vallina, Rebecca Michna
Anterior Lumbar Interbody Fusion (ALIF) has become a standard procedure in the repertoire of a minimally invasive spine surgeon and will likely be performed more often as the incidence of adult degenerative spinal disorders in the United States increases. It is beneficial for spine surgeons to be aware of technical considerations associated with an ALIF and how to prevent complications to ensure complete surgical proficiency. This case study includes two patients who underwent standalone ALIF with a fourhole implant for lumbar degenerative disease. Both patients had full strength and were ambulatory. Both patients had persistent intermittent numbness and aching in the S1 distribution that promoted evaluation. CT scan demonstrated the left-sided screw was prominent into the left S1 foramen. The imaging correlated with the patient's symptoms and both patients elected for screw removal. In both cases, screws were removed uneventfully via a novel laparoscopic method with complete resolution of leg symptoms in both patients. Furthermore, we outline the considerations of selecting screw length in each hole when using this four-hole ALIF implant.