Skip to main content

Advertisement

SpringerLink
Log in

Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Background

AxiaLIF was initially advocated as a minimally invasive, presacral lumbar fusion approach. Its use has expanded in to adult scoliosis surgeries.

Methods

Current literature about AxiaLIF for degenerative lumbar surgery and adult scoliosis surgery were reviewed. Anatomy, biomechanical properties, clinical results, and complications were summarized.

Results

Anatomically, AxiaLIF is relatively safe even though traversing blood vessels, and the pelvic splanchnic nerve can be at risk. AxiaLIF can provide significant stiffness compared to the intact spine, but posterior supplementation is recommended. AxiaLIF in the long construct for adult scoliosis surgeries can protect the S1 screw as effectively as pelvic fixation. Successful clinical outcomes after AxiaLIF were reported in the degenerative lumbar spine, adult scoliosis, and spondylolisthesis. It can facilitate a high fusion rate up to 96 % without BMP. Complications include pseudarthrosis, rectal injury, transient nerve irritation, and intrapelvic hematoma.

Conclusion

AxiaLIF is a relatively safe procedure, and it provides good clinical results in both short constructs and long constructs for adult scoliosis surgery. For a safer procedure, surgeons should seek out prior colorectal surgical history and review preoperative imaging studies carefully.

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

References

  1. Akesen B, Wu C, Mehbod AA, Transfeldt EE (2008) Biomechanical evaluation of paracoccygeal transsacral fixation. J Spinal Disord Tech 21:39–44

    Article  PubMed  Google Scholar 

  2. Anand N, Baron EM, Thaiyananthan G, Khalsa K, Goldstein TB (2008) Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis: a technique and feasibility study. J Spinal Disord Tech 21:459–467

    Article  PubMed  Google Scholar 

  3. Allen BL Jr, Ferguson RL (1988) The Galveston experience with L-rod instrumentation for adolescent idiopathic scoliosis. Clin Orthop Relat Res 229:59–69

    PubMed  Google Scholar 

  4. Aryan HE, Newman CB, Gold JJ, Acosta FL Jr, Coover C, Ames CP (2008) Percutaneous axial lumbar interbody fusion (AxiaLIF) of the L5-S1 segment: initial clinical and radiographic experience. Minim Invasive Neurosurg 51(4):225–230

    Article  PubMed  CAS  Google Scholar 

  5. Bridwell K, Edwards C, Lenke L (2003) The pros and cons to saving the L5-S1 motion segment in a long scoliosis fusion construct. Spine 28(20S):S234–S242

    Article  PubMed  Google Scholar 

  6. Bridwell KH, Kuklo T, Edwards CC II (2004) Sacropelvic fixation. Medtronic Sofamor Danek, Memphis

    Google Scholar 

  7. Cohen A, Miller LE, Block JE (2011) Minimally invasive presacral approach for revision of an Axial Lumbar Interbody Fusion rod due to fall-related lumbosacral instability: a case report. J Med Case Reports 5:488

    Article  Google Scholar 

  8. Cragg A, Carl A, Casteneda F, Dickman C, Guterman L, Oliveira C (2004) New percutaneous access method for minimally invasive anterior lumbosacral surgery. J Spinal Disord Tech 17:21–28

    Article  PubMed  Google Scholar 

  9. 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 9:910–915

    Article  PubMed  Google Scholar 

  10. Erkan S, Wu C, Mehbod AA, Hsu B, Pahl DW, Transfeldt EE (2009) Biomechanical evaluation of a new AxiaLIF technique for two-level lumbar fusion. Eur Spine J 18:807–814

    Article  PubMed  Google Scholar 

  11. Fleischer GD, Kim YJ, Ferrara LA, Freeman AL, Boachie-Adjei O (2011) Biomechanical analysis of sacral screw strain and range of motion in long posterior spinal fixation constructs: effects of lumbosacral fixation strategies in reducing sacral screw strains. SpineLook for published date

  12. Gerszten PC, Tobler WD, Nasca RJ (2011) Retrospective analysis of L5-S1 axial lumbar interbody fusion (AxiaLIF): a comparison with and without the use of recombinant human bone morphogenetic protein-2. Spine J 11:1027–1032

    Article  PubMed  Google Scholar 

  13. Gerszten PC, Tobler W, Raley TJ, Miller LE, Block JE, Nasca RJ (2011) Axial presacral lumbar interbody fusion and percutaneous posterior fixation for stabilization of lumbosacral isthmic spondylolisthesis. J Spinal Disord Tech 25(2):E36–E40

    Article  Google Scholar 

  14. Hofstetter CP, James AR, Härtl R (2011) Revision strategies for AxiaLIF. Neurosurg Focus 31:E17

    Article  PubMed  Google Scholar 

  15. Ledet EH, Carl AL, Cragg A (2006) Novel lumbosacral axial fixation techniques. Expert Rev Med Devices 3:327–334

    Article  PubMed  Google Scholar 

  16. Ledet EH, Tymeson MP, Salerno S, Carl AL, Cragg A (2005) Biomechanical evaluation of a novel lumbosacral axial fixation device. J Biomech Eng 127:929–933

    Article  PubMed  Google Scholar 

  17. Li XM, Zhang YS, Hou ZD, Wu T, Ding ZH (2011) The relevant anatomy of the approach for axial lumbar interbody fusion. Spine 37(4):266–271

    Article  CAS  Google Scholar 

  18. Lindley EM, McCullough MA, Burger EL, Brown CW, Patel VV (2011) Complications of axial lumbar interbody fusion. J Neurosurg Spine 15:273–279

    Article  PubMed  Google Scholar 

  19. Luther N, Tomasino A, Parikh K, Härtl R (2009) Neuronavigation in the minimally invasive presacral approach for lumbosacral fusion. Minim Invasive Neurosurg 52:196–200

    Article  PubMed  CAS  Google Scholar 

  20. Marotta N, Cosar M, Pimenta L, Khoo LT (2006) A novel minimally invasive presacral approach and instrumentation technique for anterior L5-S1 intervertebral discectomy and fusion: technical description and case presentations. Neurosurg Focus 20:E9

    Article  PubMed  Google Scholar 

  21. Matteini LE, Kebaish KM, Volk WR, Bergin PF, Yu WD, O’Brien JR (2010) An S-2 alar iliac pelvic fixation. Technical note. Neurosurg Focus 28(3):E13

    Article  PubMed  Google Scholar 

  22. Meyer SA, Mummaneni PV (2011) Axial interbody fusion. J Neurosurg Spine 15:271–272

    Article  PubMed  Google Scholar 

  23. Mirkovic S, Abitbol JJ, Steinman J, Edwards CC, Schaffler M, Massie J, Garfin SR (1991) Anatomic consideration for sacral screw placement. Spine 6(6S):S289–S294

    Google Scholar 

  24. Nasca RJ (2010) Re: “a novel alternative for removal of the AxiaLIF (TranS1) in the setting of pseudarthrosis of L5-S1”. Spine J 10:945–946

    Article  PubMed  Google Scholar 

  25. Patil SS, Lindley EM, Patel VV, Burger EL (2012) Clinical and radiological outcomes of axial lumbar interbody fusion. Orthopedics 33:883

    Google Scholar 

  26. Shen FH, Harper M, Foster WC, Marks I, Arlet V (2006) A novel “four-rod technique” for lumbo-pelvic reconstruction: theory and technical considerations. Spine 31(12):1395–1401

    Article  PubMed  Google Scholar 

  27. Tender GC, Miller LE, Block JE (2011) Percutaneous pedicle screw reduction and axial presacral lumbar interbody fusion for treatment of lumbosacral spondylolisthesis: a case series. J Med Case Reports 5:454

    Article  Google Scholar 

  28. Tobler WD, Ferrara LA (2011) The presacral retroperitoneal approach for axial lumbar interbody fusion: a prospective study of clinical outcomes, complications and fusion rates at a follow-up of two years in 26 patients. J Bone Joint Surg Br 93:955–960

    Article  PubMed  CAS  Google Scholar 

  29. Tobler WD, Gerszten PC, Bradley WD, Raley TJ, Nasca RJ, Block JE (2011) Minimally invasive axial presacral L5-S1 interbody fusion: two-year clinical and radiographic outcomes. Spine 36:E1296–E1301

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Hospital for Special Surgery, 525 East 71st Street, #9J, New York, NY, 10021, USA

    Oheneba Boachie-Adjei, Woojin Cho & Akilah B. King

Authors
  1. Oheneba Boachie-Adjei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Woojin Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akilah B. King
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Woojin Cho.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boachie-Adjei, O., Cho, W. & King, A.B. Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis. Eur Spine J 22 (Suppl 2), 225–231 (2013). https://doi.org/10.1007/s00586-012-2351-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2351-7

Keywords

Search

Navigation