title: Axial lumbosacral interbody fusion appears safe as a method to obtain lumbosacral arthrodesis distal to long fusion constructs.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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?
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Issack
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
keywords: AxiaLIF; degenerative; presacral lumbosacral interbody fusion