Pioneering Surgeons

Centinel began with the work of one innovator, Mr. John O’Brien, FRCS, whose Hong Kong training in the late 1960’s set the original standard for Anterior Lumbar Interbody Fusion (ALIF) surgery.

Toward the end of the 1970’s, Mr. John Dove, FRCS, studied under the guidance of Mr. O’Brien at Robert Jones & Agnes Hunt Hospital, Oswestry, England.

Above: Mr. John Dove, FRCS

Above: Mr. John O'Brien, FRCS

Mr. Dove took his training to the Hartshill Orthopaedic Hospital, Stoke-on-Trent, England, where he developed the Hartshill Horseshoe. This titanium, horseshoe-shaped device offered a large graft surface area while providing support around the apophyseal ring of the vertebral body. This design eliminated the need for supplemental fixation making it the first Integrated Interbody device.

Left: The Hartshill Horseshoe

Design Evolution

Following approximately the first 1,000 implantations, a new material, PEEK-OPTIMA^®, was introduced to address the shortcomings of Titanium. PEEK was implemented to support enhanced post-operative assessment of fusion. Additionally, PEEK’s elastic modulus was designed to be much closer to that of actual bone, reducing the risk of subsidence. This was recently validated in a 2013 study by Chen et. al¹ which reported that after 7 years there is a statistically significant higher level of subsidence with titanium cervical cages compared to PEEK cages.

¹ Chen Y, Wang X, Lu X, Yang L, Yang H, Yuan W, Chen D (2013) Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up. Eur Spine J http://dx.doi.org/10.1007/s00586-013-2772-y

Below: A Comparison of Elastic Modulus

This design was unveiled as the first “STALIF” device (STand Alone Lumbar Interbody Fusion). Featuring bone graft containment and an increased graft area, STALIF brought about wider acceptance of the use of Integrated Interbody devices.

Right: The Original STALIF Device

Continued design optimizations led to the highly successful 4-screw STALIF TT. Biomechanical testing confirmed² that the TT was statistically equivalent to a cage and plate or pedicle screws.

² Cappuccino A, MD; Cunningham BW - Multi-directional flexibility properties of the STALIF TT™ device versus circumferential spinal arthrodesis: an in-vitro spine model presentation, SAS6, Montreal, May 2006.

Left: The STALIF TT Device

Centinel adapted its lumbar design for use in the cervical spine launching the STALIF C^® in 2008. Like the TT, the 3-screw STALIF C was biomechanically verified to reduce segmental motion similarly to using conventional interbody arthrodesis cages augmented with anterior cervical plate fixation.³

³ Cappuccino A, MD; Cunningham BW - Multi-directional flexibility properties of the STALIF C^® versus conventional methods of interbody cervical arthrodesis: an in-vitro calf spine model - Nov. 2007.

Above: The STALIF C^® Device

When the STALIF MIDLINE^® anterior lumbar device was unveiled in 2010, it was also subjected to extensive biomechanical testing to ensure that the MIDLINE's 3-screw design was statistically equivalent to the previous generation STALIF TT with either 3 or 4 screws.⁴

⁴ Cappuccino A, MD, SAS 11, Las Vegas, NV April 2011.

Above: The STALIF MIDLINE^® Device

Based on the successful design rationale of the STALIF MIDLINE^® device, STALIF M™ was released in 2014. With improvements such as a 17% reduction in the surgical envelope, a 70% larger graft area, and a greater A/P depth, STALIF M™ represents a welcome addition to the STALIF^® family of products.⁵

⁵ Comparisons based on measurements from CAD drawings demonstrating STALIF M™ compared to STALIF MIDLINE^®

Right: The STALIF M™ Device

Centinel Spine's Ti-ACTIVE™ Titanium-Enhanced PEEK Technology was introduced in 2014 with the launch of the STALIF C-Ti™ anterior cervical device and followed in 2015 by the STALIF M-Ti™ anterior lumbar device—merging the established advantages of Titanium with the benefits of PEEK and the proven success of STALIF^® technology.

Above: The STALIF M-Ti™ and STALIF C-Ti™ Devices with Ti-ACTIVE™ Surface

Now and Into the Future

Innovation remains the focus for Centinel Spine. Centinel continues to advance Integrated Interbody devices through new components and features, such as:

Proprietary cancellous screws with ABO® (Anti Back-Out) technology.

Larger graft containment areas.

Converging screws for increased pullout resistance.

Multiple device footprints and geometries to accommodate a wider cross section of patients.