title: L5/S1 Fusion Rates in Degenerative Spine Surgery: A Systematic Review Comparing ALIF, TLIF, and Axial Interbody Arthrodesis.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To determine the fusion rate of an anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), and axial arthrodesis at the lumbosacral junction in adult patients undergoing surgery for 1- and 2-level degenerative spine conditions.
  
  
  BACKGROUND
  An L5/S1 interbody fusion is a commonly performed procedure for pathology such as spondylolisthesis with stenosis; however, it is unclear if 1 technique leads to superior fusion rates.
  
  
  METHODS
  A systematic search of MEDLINE was conducted for literature published between January 1, 1992 and August 17, 2014. All peer-reviewed articles related to the fusion rate of L5/S1 for an ALIF, TLIF, or axial interbody fusion were included.
  
  
  RESULTS
  In total, 42 articles and 1507 patients were included in this systematic review. A difference in overall fusion rates was identified, with a rate of 99.2% (range, 96.4%-99.8%) for a TLIF, 97.2% (range, 91.0%-99.2%) for an ALIF, and 90.5% (range, 79.0%-97.0%) for an axial interbody fusion (P=0.005). In a paired analysis directly comparing fusion techniques, only the difference between a TLIF and an axial interbody fusion was significant. However, when only cases in which bilateral pedicle screws supported the interbody fusion, no statistical difference (P>0.05) between the 3 techniques was identified.
  
  
  CONCLUSIONS
  The current literature available to guide the treatment of L5/S1 pathology is poor, but the available data suggest that a high fusion rate can be expected with the use of an ALIF, TLIF, or axial interbody fusion. Any technique-dependent benefit in fusion rate can be eliminated with common surgical modifications such as the use of bilateral pedicle screws.
authors: *The Rothman Institute †Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA.
authors: Gregory D
authors: GD
authors: Schroeder
authors: Christopher K
authors: CK
authors: Kepler
authors: Paul W
authors: PW
authors: Millhouse
authors: Andrew N
authors: AN
authors: Fleischman
authors: Mitchell G
authors: MG
authors: Maltenfort
authors: Dexter K
authors: DK
authors: Bateman
authors: Alexander R
authors: AR
authors: Vaccaro
mesh_terms: D001174:Arthrodesis; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D012447:Sacrum / Q000601:surgery*; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion