In an alif, what factors go into your decision to use allograft vs autograft? which would you recommend for a patient with autoimmune issues?

Multiple factors: Using an allograft when it is possible prevents the need to harvest a bone graft. However in patients who are expected to have problems with healing and incorporation of a bone graft an autograft is preferable.

ALIF Allograft: I typically do not use allografts unless there is a reason. In the neck, after removing an entire vertebral bone, a structural bone is my preference. In the lumbar spine, fusion rates using fresh frozen femoral allografts are fair—autograft is still superior. Allograft is quick/easy. But, so is a cage filled with a bone graft product—my preference over structural allograft. Personal preference.