Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up

Clinical article

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Object

Axial lumbar interbody fusion (AxiaLIF) is a minimally invasive presacral surgical technique that damages neither the anulus fibrosus nor the anterior or posterior longitudinal ligaments. The technique was initially designed and used for L5–S1 interbody fusions and recently was extended to 2-level fusions (L4–5 and L5–S1). Until now, only biomechanical and radiological studies have discussed the feasibility of this new indication, and no clinical study has been published. The purpose of this article is to report results and complications associated with 2-level presacral AxiaLIF with a minimum of 24 months of follow-up.

Methods

In this prospective, nonrandomized, single-center study, 27 patients underwent presacral AxiaLIF surgery at the L4–5 and L5–S1 levels. Clinical outcomes were assessed using the visual analog scale for back and leg symptoms and the Oswestry Disability Index. Radiographic parameters, such as disc height, segmental lordosis, and bone fusion, were analyzed using radiographs and CT scans. Complications and revision surgeries were recorded as needed. The minimum follow-up was 24 months (up to 72 months).

Results

There were no intraoperative complications. One major complication was observed: a patient developed septicemia that resolved after proper care. Clinical outcomes scores showed overall improvement in pain and physical function. During follow-up, the following complications were observed in the construct: screw breakage (14.8%), proximal/distal transsacral rod detachment (11.1%), radiolucency around the transsacral rod (52%), and cephalic rod migration (24%). Disc height gain was reported early after surgery, but at the 24-month follow-up the disc space was diminished in comparison with the preoperative status. Compared with preoperative values, the 24-month results showed loss of segmental lordosis. Only 22% of all treated levels were considered to have solid fusion at the 24-month radiological evaluation.

Conclusions

Patients undergoing presacral 2-level AxiaLIF experienced satisfactory short-term clinical outcomes; however, complications were commonly seen on imaging studies obtained 24 months postoperatively. Additional studies are required to better understand the 2-level indications for this technique.

Abbreviations used in this paper:AxiaLIF = axial lumbar interbody fusion; ODI = Oswestry Disability Index; VAS = visual analog scale.

Article Information

Address correspondence to: Luiz Pimenta, M.D., Ph.D., Vergueiro Street 1421, Room 305, 04101-000, Sao Paulo, Brazil. email: luizpimenta@luizpimenta.com.br.

Please include this information when citing this paper: published online July 17, 2012; DOI: 10.3171/2012.6.SPINE11915.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Clinical outcomes. Upper: Line graph showing the VAS for back and leg pain. Postoperative scores are statistically significant compared with baseline (p < 0.05) except for the 12-month leg pain score. Lower: Bar graph showing the ODI scores. Postoperative scores are statistically lower than preoperative from 6 to 24 months (p < 0.05).

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    Case example in which retrieval was necessary after 7 months. Radiographs obtained preoperatively (A), at 6 weeks (B), at 6 months (neutral [C], extension [E], and flexion [F]), and after revision (I). Sagittal (D) and axial CT reconstructions at the L-5 (G) and L-4 (H) vertebral bodies obtained at 6 months.

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    Case example in which axial rod had entered L3–4 disc space and damaged the L-3 inferior endplate. Preoperative MRI study (A). Radiographs obtained at 6 weeks (B) and at 24 months (extension [D], neutral [E], and flexion [F]). Computed tomography scan obtained at 6 months (C).

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    Case example showing postoperative loss of L4–5 and L5–S1 disc height, L3–4 disc space invasion at 24 months, and L3–S1 fusion at 60 months. Radiographs obtained preoperatively (A), at 6 weeks (B), at 24 months (C), and at 60 months (F). Computed tomography scans obtained at 24 months at L-4 (D) and L-5 (E). Coronal CT scan obtained at 60 months (G).

  • View in gallery

    Case example showing good results. There are no signs of radiolucency, and intervertebral fusion was achieved with maintenance of disc height and lordosis. Radiograph (A) and CT scan (B) obtained at 6 months. Radiograph obtained at 60 months postoperatively (C). AR = AxiaLIF rod.

References

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