This video explains a new anterior only approach for Lumbar Fusion which spares the posterior musculature. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Lumbar Fusion feel free to look us up online www.beverlyspine.com or call toll free 1-8SPINECAL-1

1. STALIF Single Incision 360 o TM Pablo Pazmiño, MD Beverly Hills, CA

6. MIS PLIF/TLIF

8. The MIS Approach

9. The Reality

10. Anterior-Posterior (360 o ) Approach Pain source removed Movement through disc prevented Sagittal balance restored Low associated morbidity Muscle function preserved Yes Yes Yes ? ? Achieved

12. What about Cages & Anterior Lumbar Plating?

13. Vascular Anatomy Bifurcation – Variations ( high / low) Ilio-lumbar vein –Often ligated to access to L4/5 Pre-sacral vessels –Isolated /ligated to access L5/S1 Anterior Plates may have the potential to Erode Great Vessels/DVT

16. Reminiscent of Humeral Plating Systems

20. STALIF ™- Single Incision 360™ Pain source removed Movement through disc prevented Sagittal balance restored Low associated morbidity Muscle function preserved Yes Yes Yes Yes Yes Achieved

26. 2) LT Peek cages + anterior Pyramid plate with screws LT Cage + Pyramid Anterior Plate (n=7) The bilateral LT cages were augmented using the Pyramid Anterior Plate (Medtronic Sofamor Danek, Inc.), which was inserted anteriorly spanning the operative L4-L5 level. Two screws were inserted at the inferior level and one superiorly

29. STUDY GROUPS

35. Biomechanical Data

36. NON DESTRUCTIVE ROM AXIAL ROTATION Error bars represent one standard deviation and significance is indicated at p<0.05. Intact demonstrated more motion compared to LT Cages+ pedicle screws and STALIF groups (p<0.05).

37. LATERAL BENDING ROM : Z Axis . No other comparisons between the six reconstruction groups were statistically significant (p>0.05) (One Way ANOVA: F=24.32, p=0.000)

38. FLEXION-EXTENSION ROM No S. differences were noted between STALIF and LTPS construct (p>0.05) (One Way ANOVA: F=26.55, p=0.000)

39. EXTENSION LOAD TO FAILURE LT Cage combined with pedicle screws as producing the greatest mean moment at failure compared to the remaining treatments, however, was not statistically different from the other treatments (p>0.05

51. Intra-operative trial placement and proper location

52. Permanent Implant Position

56. Post Operative XRays

57. 4 Month Post Op CT

58. Case 2 : Hybrid Scenario 3 Month Post Op CT

62. Dr Pazmiño: Spine Surgeon Dr. Wagmeister: Vascular Surgeon

63. Dr Lauryssen: Neurolgical Spine Dr Pazmiño: Orthopaedic Spine

64. Just prior to implantation of a STALIF

66. STALIF Inserted: Final View Prior to Closure