title: Axial interbody arthrodesis of the L5-S1 segment: a systematic review of the literature.
abstract: OBJECTIVE
  The object of this study was to determine the fusion rate and safety profile of an axial interbody arthrodesis of the L5-S1 motion segment.
  
  
  METHODS
  A systematic search of MEDLINE was conducted for literature published between January 1, 2000, and August 17, 2014. All peer-reviewed articles related to the fusion rate of L5-S1 and the safety profile of an axial interbody arthrodesis were evaluated.
  
  
  RESULTS
  Seventy-four articles were identified, but only 15 (13 case series and 2 retrospective cohort studies) met the study inclusion criteria. The overall pseudarthrosis rate at L5-S1 was 6.9%, and the rate of all other complications was 12.9%. A total of 14.4% of patients required additional surgery, and the infection rate was 5.4%. Deformity studies reported a significantly increased rate of complications (46.3%), and prospectively collected data demonstrated significantly higher complication (36.8%) and revision (22.6%) rates. Lastly, studies with a conflict of interest reported lower complication rates (12.4%).
  
  
  CONCLUSIONS
  A systematic review of the literature indicates that an axial interbody fusion performed at the lumbosacral junction is associated with a high fusion rate (93.15%) and an acceptable complication rate (12.90%). However, these results are based mainly on retrospective case series by authors with a conflict of interest. The limited prospective data available indicate that the actual fusion rate may be lower and the complication rate may be higher than currently reported.
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D012086:Reoperation; D012447:Sacrum / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: ALIF = anterior lumbar interbody fusion; GLMM = generalized linear mixed model; S1 fusion; lumbar; axial interbody arthrodesis; systematic review; Axialif; L5; rhBMP-2 = recombinant human bone morphogenetic protein 2