A novel alternative for removal of the AxiaLif (TranS1) in the setting of pseudarthrosis of L5–S1

DeVine, John G.; Gloystein, David M.; Singh, Niten

doi:10.1016/j.spinee.2009.08.459

Cited by 18 publications

(12 citation statements)

References 14 publications

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“…We believed that removal of the axial fixation rod through the same paracoccygeal presacral corridor was ill advised due to the likely scarring of the presacral space. DeVine et al 5 suggested an anterior paramedian approach for removal of the AxiaLIF system; however, as this patient was obese and had a nearby rectocutaneous fistula, and we anticipated a lot of scar tissue regardless of approach, we elected to leave the axial fixation rod in place. We performed instead a posterolateral and transforaminal lumbar interbody fusion of L5-S1 and treated the patient with long-term antibiotic suppression therapy.…”

Section: Discussionmentioning

confidence: 99%

Rectocutaneous fistula and nonunion after TranS1 axial lumbar interbody fusion L5–S1 fixation

Siegel

Patel

Ramakrishnan

2013

SPI

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The authors report a case of rectal injury, rectocutaneous fistula, and pseudarthrosis after a TranS1 axial lumbar interbody fusion (AxiaLIF) L5–S1 fixation. The TranS1 AxiaLIF procedure is a percutaneous minimally invasive approach to transsacral fusion of the L4–S1 vertebral levels. It is gaining popularity due to the ease of access to the sacrum through the presacral space, which is relatively free from intraabdominal and neurovascular structures. This 35-year-old man had undergone the procedure for the treatment of degenerative disc disease. The patient subsequently presented with fever, syncope, and foul-smelling gas and bloody drainage from the surgical site. A CT fistulagram and flexible sigmoidoscopy showed evidence of rectocutaneous fistula, which was managed with intravenous antibiotic therapy and bowel rest with total parenteral nutrition. Subsequent studies performed 6 months postoperatively revealed evidence of pseudarthrosis. The patient's rectocutaneous fistula symptoms gradually subsided, but his preoperative back pain recurred prompting a revision of his L5–S1 spinal fusion.

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Section: Discussionmentioning

confidence: 99%

Rectocutaneous fistula and nonunion after TranS1 axial lumbar interbody fusion L5–S1 fixation

Siegel

Patel

Ramakrishnan

2013

SPI

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“…The patient in this case study had an uneventful surgery and recovered with minimal postoperative pain. 25 A CT scan at the patient's 6-month follow-up showed solid arthrodesis at L5-S1 outside the ALIF spacer. This report is the first and only to outline a standard approach for AxiaLIF device removal for pseudarthrosis.…”

Section: Axialif Safetymentioning

confidence: 95%

“…Once the rod was exposed, a large heavy needle driver was used to grasp and remove the rod. 25 This step was followed by a revision ALIF, then a removal and replacement of posterior instrumentation. The patient in this case study had an uneventful surgery and recovered with minimal postoperative pain.…”

Section: Axialif Safetymentioning

confidence: 99%

Presacral Approach for L5-S1 Fusion

Durrani¹,

Mistur²,

Shanti³

2011

Techniques in Orthopaedics

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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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“…DeVine et al [9] reported on an AxiaLIF psuedarthrosis revision where a paramedian approach was performed and the AxiaLIF cage was removed through the anterior L5-S1 disc space. Regarding this innovative technique, Nasca [24] commented that the removal of an AxiaLIF cage through the previous presacral approach tract has been safe in 50 removals out of 8,600 AxiaLIF cases.…”

Section: Complicationsmentioning

confidence: 99%

Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis

2012

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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.

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A novel alternative for removal of the AxiaLif (TranS1) in the setting of pseudarthrosis of L5–S1

Cited by 18 publications

References 14 publications

Rectocutaneous fistula and nonunion after TranS1 axial lumbar interbody fusion L5–S1 fixation

Rectocutaneous fistula and nonunion after TranS1 axial lumbar interbody fusion L5–S1 fixation

Presacral Approach for L5-S1 Fusion

Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis

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