Biomechanical evaluation of a new AxiaLIF technique for two-level lumbar fusion

Erkan, Serkan; Wu, Chunhui; Mehbod, Amir A.; Hsu, Brian; Pahl, Douglas W.; Transfeldt, Ensor E.

doi:10.1007/s00586-009-0953-5

Cited by 40 publications

(38 citation statements)

References 21 publications

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“…In order to obtain the optimal biomechanical properties, however, they recommended that posterior fixation, such as facet screws or pedicle screws, should be added. Erkan et al [10] showed similar results in two-level axial fixation. The stand-alone axial two-level fixation showed a reduced range of motion compared to the intact specimen, but posterior supplemental fixation showed better stiffness than the stand-alone axial two-level fixation.…”

Section: Biomechanical Propertiesmentioning

confidence: 76%

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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Section: Biomechanical Propertiesmentioning

confidence: 76%

Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis

2012

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“…4,19 Biomechanical and preliminary clinical data suggest good short-term outcomes for axial lumbar interbody fusion for degenerative disc disease, spondylolisthesis and as anterior support caudal to long fusion constructs. 6,9,17,20 …”

Section: Interbody Arthrodesismentioning

confidence: 99%

“…6,9,17,20 Ledet and colleagues 17 mechanically tested 24 bovine lumbar motion segments in sagittal and lateral bending, torsion, and axial compression after drilling an axial canal and implanting a fixation rod within the drilled canal. Drilling had little effect on stiffness and range of motion of the specimens.…”

Section: Biomechanical Evaluationmentioning

confidence: 99%

“…Thus the stiffness of the axial rod is comparable to or greater than that of existing fixation devices, which suggests that biomechanically it is a good implant for obtaining lumbosacral interbody fusion. 17 Erkan and colleagues 9 have tested 2-level fusion (L4-S1) using the axial rod technique. Six human cadaveric L4-S1 motion segments were tested in axial torsion, lateral bending, and flexion-extension following intact, standalone AxiaLIF (2-level rod), and AxiaLIF with posterior fixation and either facet screw or pedicle screw placement.…”

Section: Biomechanical Evaluationmentioning

confidence: 99%

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The axial transsacral approach to interbody fusion at L5–S1

Issack

Kotwal²,

Boachie-Adjei³

2014

FOC

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Lumbosacral interbody fusion may be indicated to treat degenerative disc disease at L5–S1, instability or spondylolisthesis at that level, and severe neural foraminal stenosis resulting from loss of disc space height. In addition, L5–S1 interbody fusion may provide anterior support to a long posterior fusion construct and help offset the stresses experienced by the distal-most screws. There are 3 well-established techniques for L5–S1 interbody fusion: anterior lumbar interbody fusion, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion. Each of these has advantages and pitfalls. A more recently described axial transsacral technique, utilizing the presacral corridor, may represent a minimally invasive approach to obtaining lumbosacral interbody arthrodesis. Biomechanical studies demonstrate that the stiffness of the axial rod is comparable to existing fixation devices, suggesting that, biomechanically, it may be a good implant for obtaining lumbosacral interbody fusion. Clinical studies have demonstrated good early results with the use of the axial transsacral approach in obtaining lumbosacral interbody fusion for degenerative disc disease, spondylolisthesis, and below long posterior fusion constructs. The technique is exacting and complications can be major, including rectal perforation and fistula, loss of correction, and pseudarthrosis.

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“…1,6 However, both studies also showed that additional posterior fixation, such as facet screws or pedicle screws, is required to achieve better construct stability for successful fusion. Most surgeons opt to simultaneously place posterior facet or pedicle screws due to the potential for higher stability of the fusion.…”

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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Biomechanical evaluation of a new AxiaLIF technique for two-level lumbar fusion

Cited by 40 publications

References 21 publications

Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis

Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis

The axial transsacral approach to interbody fusion at L5–S1

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

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