Abstract
Axial lumbar interbody fusion (AxiaLIF; Trans1 Inc., Wilmington, NC) offers a presacral approach to L4-L5 and L5-S1 fusions. This minimally invasive procedure has been successfully used for the treatment of degenerative disc disease, spondylolisthesis, and spinal stenosis, among other conditions. Open anterior lumbar interbody fusion (ALIF) procedures are associated with significant morbidity and vascular and visceral complications. Open ALIF requires disruption of the annulus and sectioning of the anterior longitudinal ligament, which can weaken the motion segment. Comparison of several large-scale AxiaLIF studies with results from open fusion techniques show comparable fusion rates and clinical outcomes at 2-year follow-up. However, AxiaLIF patients show reduced estimated blood loss, hospital stay, complications, and overall decreased morbidity when compared with patients who undergo open fusion. The studies cited in this review support the safety of this presacral annulus-sparing approach and demonstrate low incidence of vascular and visceral injuries. Our clinical experience with this procedure confirms these findings. Overall, this minimally invasive, alternative approach for L4-L5 and L5-S1 fusion appears to offer several potential advantages over open techniques for lumbar fusion in appropriate patient candidates.
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