Skip to main content

Advertisement

SpringerLink
Log in

Trans-sacral interbody fixation in long fusions to the sacrum for adult spinal deformity: complications and fusion rates at minimum two years follow-up

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study aims to investigate the fusion rate and complications associated with trans-sacral interbody fusion (TSIF) in long fusions to the sacrum for adult spinal deformity (ASD) over a two year follow-up period. Potential predictor variables associated with pseudarthrosis were also examined.

Methods

A retrospective clinical review was conducted on a consecutive series of ASD patients who underwent long fusions to the sacrum, with TSIF performed as a same-day or staged procedure. Patient demographics, bone mineral density, operative details, perioperative and late complications, and fusion rates were reviewed. Univariate analysis was used to identify the risk factors associated with pseudarthrosis.

Results

The study included 43 patients with an average age of 55.3 ± 8.9 years. The perioperative complication rate was 28%, with 12% of the complications directly related to TSIF. The late complication rate was 33%, with 16% related to TSIF. The most common complications were pseudarthrosis (14%) and postoperative ileus (7%). The overall radiographic fusion rate at two years was 86%. Univariate analysis revealed that revision surgery was significantly associated with pseudarthrosis (p = 0.027). Over the follow-up period, patients who underwent TSIF during long posterior fusions to the sacrum showed improvement in overall SRS scores, ODI scores, and SF-36 physical health and mental health (p < 0.05).

Conclusion

TSIF is a relatively safe and minimally invasive method for achieving interbody fusion at the lumbosacral junction in the treatment of ASD, with acceptable fusion rates and a low complication rate. However, TSIF is not recommended for revision reconstruction in ASD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Lambrechts MJ, Toci GR, Siegel N et al (2023) Revision lumbar fusions have higher rates of reoperation and result in worse clinical outcomes compared to primary lumbar fusions. Spine J 23(1):105–115. https://doi.org/10.1016/j.spinee.2022.08.018

    Article  PubMed  Google Scholar 

  2. Lyu Q, Lau D, Haddad AF et al (2021) Multiple-rod constructs and use of bone morphogenetic protein-2 in relation to lower rod fracture rates in 141 patients with adult spinal deformity who underwent lumbar pedicle subtraction osteotomy. J Neurosurg Spine 24:1–11. https://doi.org/10.3171/2021.3.SPINE201968

    Article  Google Scholar 

  3. Peck JH, Kavlock KD, Showalter BL et al (2018) Mechanical performance of lumbar intervertebral body fusion devices: an analysis of data submitted to the food and drug administration. J BIOMECH 78:87–93. https://doi.org/10.1016/j.jbiomech.2018.07.022

    Article  PubMed  Google Scholar 

  4. de Kunder SL, van Kuijk SMJ, Rijkers K et al (2017) Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J 17(11):1712–1721. https://doi.org/10.1016/j.spinee.2017.06.018

    Article  PubMed  Google Scholar 

  5. Rathbone J, Rackham M, Nielsen D et al (2023) A systematic review of anterior lumbar interbody fusion (ALIF) versus posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), posterolateral lumbar fusion (PLF). Eur Spine J 32(6):1911–1926. https://doi.org/10.1007/s00586-023-07567-x

    Article  PubMed  Google Scholar 

  6. Akesen B, Wu C, Mehbod AA et al (2008) Biomechanical evaluation of paracoccygeal transsacral fixation. J Spinal Disord Tech 21(1):39–44. https://doi.org/10.1097/BSD.0b013e3180577242

    Article  PubMed  Google Scholar 

  7. Karim A, Mukherjee D, Ankem M et al (2006) Augmentation of anterior lumbar interbody fusion with anterior pedicle screw fixation: demonstration of novel constructs and evaluation of biomechanical stability in cadaveric specimens. Neurosurgery 58(3):522–527. https://doi.org/10.1227/01.NEU.0000197322.52848.C8

    Article  PubMed  Google Scholar 

  8. Boachie-Adjei O, Cho W, King AB (2013) Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis. EUR SPINE J 22(S2):225–231. https://doi.org/10.1007/s00586-012-2351-7

    Article  Google Scholar 

  9. Fiani B, Siddiqi I, Chacon D et al (2021) Paracoccygeal transsacral approach: a rare approach for axial lumbosacral interbody fusion. Spine Surg Relat Res. 5(4):223–231. https://doi.org/10.22603/ssrr.2020-0179

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gerszten PC, Tobler W, Raley TJ et al (2012) Axial presacral lumbar interbody fusion and percutaneous posterior fixation for stabilization of lumbosacral isthmic spondylolisthesis. J Spinal Disord Tech 25(2):E36–E40. https://doi.org/10.1097/BSD.0b013e318233725e

    Article  PubMed  Google Scholar 

  11. Lovecchio F, Qureshi SA (2019) The current state of minimally invasive approaches to adult spinal deformity. Curr Rev Musculoske 12(3):318–327. https://doi.org/10.1007/s12178-019-09570-6

    Article  Google Scholar 

  12. Tobler WD, Ferrara LA (2011) The presacral retroperitoneal approach for axial lumbar interbody fusion. J Bone Joint Surg Br Vol 93(7):955–960. https://doi.org/10.1302/0301-620X.93B7.25188

    Article  CAS  Google Scholar 

  13. Cragg A, Carl A, Casteneda F et al (2004) New percutaneous access method for minimally invasive anterior lumbosacral surgery. J Spinal Disord Tech 17(1):21–28. https://doi.org/10.1097/00024720-200402000-00006

    Article  PubMed  Google Scholar 

  14. Fleischer GD, Kim YJ, Ferrara LA et al (2012) Biomechanical Analysis of sacral screw strain and range of motion in long posterior spinal fixation constructs. Spine 37(3):E163–E169. https://doi.org/10.1097/BRS.0b013e31822ce9a7

    Article  PubMed  Google Scholar 

  15. Issack PS, Boachie-Adjei O (2012) Axial lumbosacral interbody fusion appears safe as a method to obtain lumbosacral arthrodesis distal to long fusion constructs. HSS Journal ® 8(2):116–121. https://doi.org/10.1007/s11420-011-9227-y

    Article  PubMed  Google Scholar 

  16. Anand N, Rosemann R, Khalsa B et al (2010) Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis. Neurosurg Focus 28(3):E6. https://doi.org/10.3171/2010.1.FOCUS09272

    Article  PubMed  Google Scholar 

  17. Benson JC, Lehman VT, Sebastian AS et al (2022) Successful fusion versus pseudarthrosis after spinal instrumentation: a comprehensive imaging review. Neuroradiology 64(9):1719–1728. https://doi.org/10.1007/s00234-022-02992-z

    Article  PubMed  Google Scholar 

  18. Choi HY, Jo DJ (2021) Utilization of S1 foraminal hooks for augmentation of s1 screws in adult spinal deformity surgery: comparative study with iliac screws. Neurospine 18(3):554–561. https://doi.org/10.14245/ns.2142148.074

    Article  PubMed  PubMed Central  Google Scholar 

  19. How NE, Street JT, Dvorak MF et al (2019) Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors. Neurosurg Rev 42(2):319–336. https://doi.org/10.1007/s10143-018-0951-3

    Article  PubMed  Google Scholar 

  20. Miller L, Tobler W, Melgar M et al (2013) Clinical and radiographic outcomes with L4–S1 axial lumbar interbody fusion (AxiaLIF) and posterior instrumentation: a multicenter study. Med Devices: Evid Res 6:155. https://doi.org/10.2147/MDER.S48442

    Article  Google Scholar 

  21. DeVine JG, Gloystein D, Singh N (2009) A novel alternative for removal of the AxiaLif (TranS1) in the setting of pseudarthrosis of L5–S1. Spine J 9(11):910–915. https://doi.org/10.1016/j.spinee.2009.08.459

    Article  PubMed  Google Scholar 

  22. Nasca RJM (2010) Re: “A novel alternative for removal of the AxiaLIF (TranS1) in the setting of pseudarthrosis of L5–S1.” Spine J 10(10):945–946. https://doi.org/10.1016/j.spinee.2010.06.003

    Article  PubMed  Google Scholar 

  23. Hofstetter CP, James AR, Härtl R (2011) Revision strategies for AxiaLIF. Neurosurg Focus 31(4):E17. https://doi.org/10.3171/2011.8.FOCUS11139

    Article  PubMed  Google Scholar 

Download references

Funding

We acknowledge support from the following grants: (1) the Science and Technology Planning Project of Guangdong Province (2017B030314139, H X) and (2) the Natural Science Foundation of Guangdong Province (2015A030312004, H X). These grants had no role in the design or execution of this study or the reporting of results.

Author information

Author notes

  1. Honglei Yi and Hu Chen contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. People’s Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China

    Honglei Yi & Hong Xia

  2. The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China

    Honglei Yi, Hu Chen, Peirong Lian & Hong Xia

  3. Chinese PLA General Hospital, Beijing, China

    Xinran Ji

  4. Hospital for Special Surgery, New York, NY, 10021, USA

    Matthew E. Cunningham, Oheneba Boachie-Adjei, Han jo Kim, Thomas Ross & Venu M. Nemani

Authors
  1. Honglei Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peirong Lian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xinran Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew E. Cunningham
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Oheneba Boachie-Adjei
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Han jo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Venu M. Nemani
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hong Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study’s conception and design. Data collection and analysis were performed by Honglei Yi, Hu Chen, and Peirong Lian. The first draft of the manuscript was written by Honglei Yi and Hu Chen. All authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Honglei Yi or Hong Xia.

Ethics declarations

Ethics approval and consent to participate

This is an observational study. The General Hospital of Southern Theatre Command Research Ethics Committee has confirmed that no ethical approval is required. Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yi, H., Chen, H., Lian, P. et al. Trans-sacral interbody fixation in long fusions to the sacrum for adult spinal deformity: complications and fusion rates at minimum two years follow-up. International Orthopaedics (SICOT) 48, 193–200 (2024). https://doi.org/10.1007/s00264-023-05951-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-023-05951-2

Keywords

Search

Navigation