The innovative AxiaLIF (Axial Lumbar Interbody Fusion) technique has revolutionized spinal surgery by offering a minimally invasive approach to interbody fusion, specifically targeting the L5-S1 level and more recently extended to L4-L5. This method utilizes a presacral corridor, enabling access to the lumbosacral disc without compromising critical neurovascular structures.
Basics of the Presacral Approach
The presacral pathway takes advantage of an anatomically “safe” space that limits the risk of injury to surrounding tissues. This approach avoids the dissection of muscles and ligaments, maintaining the integrity of the paravertebral musculature and anterior and posterior longitudinal ligaments, which supports faster recovery.
Surgical Procedure and Technical Aspects
The procedure begins with specific preparation and the prone positioning of the patient under fluoroscopy, followed by a minimal incision in the paracoccygeal area. Through a guide pin and a series of dilators, an operative channel is created to the L5-S1 intervertebral disc, preserving surrounding tissue and allowing for a minimally invasive intervention.
Patient Benefits and Recovery Reduction
The AxiaLIF approach offers numerous advantages, including shortened hospital stays and reduced postoperative complications. Compared to traditional techniques, AxiaLIF has significantly decreased hospitalization time and surgical complications, while showing efficacy in alleviating lower back pain and disability.
Risk and Safety Considerations
Although the presacral approach significantly reduces the risk of nerve and vessel injury, it is not without risks. The procedure can involve complications like pseudoarthrosis and device migration, often requiring additional fixation through pedicle screws.
Clinical Outcomes and Effectiveness Studies
Clinical studies have reported a 94% fusion rate with AxiaLIF, comparable to that of more invasive techniques. Significant improvements in lower back pain and functionality have been recorded, validating the long-term success of treatment for degenerative pathological conditions.
Evolution and Development of the AxiaLIF Approach
Over the years, the AxiaLIF technique has evolved by expanding its indications and applicability. Initially conceived for the L5-S1 segment, it has been extended to address two-level fusions, further enhancing its effectiveness.
In summary, the innovative presacral AxiaLIF approach offers a modern solution to the demands of minimally invasive spinal surgery. Based on extensive clinical evaluations and long-term results, this technique promises a future of more effective and safer treatments for patients with degenerative spinal disorders.
References
Dick J Zeilstra, Larry E Miller, Jon E Block; Axial lumbar interbody fusion: a 6-year
single-center experience; Clinical Interventions in Aging 2013:8 1063–1069; Dovepress.
W. D. Tobler, L. A. Ferrara; The presacral retroperitoneal approach for
axial lumbar interbody fusion; VOL. 93-B, No. 7; The journal of bone and joint surgery, 2011.
W. Daniel Bradley, Michael S. Hisey, Sunita Verma-Kurvari, Donna D. Ohnmeiss; Minimally invasive trans-sacral approach to L5-S1 interbody fusion: Preliminary results from 1 center and review of the literature; International Journal of Spine Surgery 6 (2012) 110 –114.
Akshitkumar M. Mistry, Saniya S. Godil, Scott L. Parker, Matthew J. McGirt; Axial Presacral Lumbar Interbody Fusion: A Systematic Literature Review; Vol. 17, No. 3; Journal of Managed Care Medicine, 2014
