Axial Lumbosacral Interbody Fusion Appears Safe as a Method to Obtain Lumbosacral Arthrodesis Distal to Long Fusion Constructs



Current methods to achieve lumbosacral interbody fusion have been complicated by approach-related morbidity, nerve root or cauda equina injury, or difficulty in implanting a large lordotic graft posteriorly. There is little information in the literature evaluating the presacral axial approach to the lumbosacral disc space.


What are the short-term clinical and radiographic outcomes in patients undergoing axial lumbosacral interbody fixation and fusion at the end of long fusion constructs using the AxiaLIF implant (Trans1 Inc., Wilmington, NC, USA)? Furthermore, what complications are associated with this procedure?

Patients and Methods

We performed a retrospective evaluation of nine patients who underwent presacral axial lumbosacral interbody fixation and fusion at the end of long fusion constructs using the AxiaLIF implant. Preoperative diagnoses included adjacent segment degeneration below a long fusion construct for adult scoliosis and progressive sagittal plane deformity.


There were two pseudoarthroses, one at L4–5 and one at L5–S1. No major complications occurred. There were no significant differences in coronal or sagittal plane alignment at the time periods measured. There was no significant difference in implant position between immediate postoperative and final follow-up periods. There were significant postoperative improvements in Scoliosis Research Society-22 scores, specifically in the pain, self-image, and satisfaction with management domains.


The axial lumbosacral interbody fusion is a minimally invasive and safe method to obtain lumbosacral fixation and arthrodesis distal to a long fusion construct. Longer follow-up of larger numbers of patients are needed prior to recommending this procedure as a routine method to fuse L4–5 or L5–S1.

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One author (O.B-A.) certifies that he has received or may receive payments or benefits from a commercial entity related to this work.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.

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Correspondence to Paul S. Issack M.D., Ph.D..

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Level of Evidence: Therapeutic Study Level IV.

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Issack, P.S., Boachie-Adjei, O. Axial Lumbosacral Interbody Fusion Appears Safe as a Method to Obtain Lumbosacral Arthrodesis Distal to Long Fusion Constructs. HSS Jrnl 8, 116–121 (2012).

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  • presacral lumbosacral interbody fusion
  • degenerative
  • AxiaLIF