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Yi H, Chen H, Lian P, Ji X, Cunningham ME, Boachie-Adjei O, Kim HJ, Ross T, Nemani VM, Xia H. Trans-sacral interbody fixation in long fusions to the sacrum for adult spinal deformity: complications and fusion rates at minimum two years follow-up. INTERNATIONAL ORTHOPAEDICS 2024; 48:193-200. [PMID: 37620580 DOI: 10.1007/s00264-023-05951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This study aims to investigate the fusion rate and complications associated with trans-sacral interbody fusion (TSIF) in long fusions to the sacrum for adult spinal deformity (ASD) over a two year follow-up period. Potential predictor variables associated with pseudarthrosis were also examined. METHODS A retrospective clinical review was conducted on a consecutive series of ASD patients who underwent long fusions to the sacrum, with TSIF performed as a same-day or staged procedure. Patient demographics, bone mineral density, operative details, perioperative and late complications, and fusion rates were reviewed. Univariate analysis was used to identify the risk factors associated with pseudarthrosis. RESULTS The study included 43 patients with an average age of 55.3 ± 8.9 years. The perioperative complication rate was 28%, with 12% of the complications directly related to TSIF. The late complication rate was 33%, with 16% related to TSIF. The most common complications were pseudarthrosis (14%) and postoperative ileus (7%). The overall radiographic fusion rate at two years was 86%. Univariate analysis revealed that revision surgery was significantly associated with pseudarthrosis (p = 0.027). Over the follow-up period, patients who underwent TSIF during long posterior fusions to the sacrum showed improvement in overall SRS scores, ODI scores, and SF-36 physical health and mental health (p < 0.05). CONCLUSION TSIF is a relatively safe and minimally invasive method for achieving interbody fusion at the lumbosacral junction in the treatment of ASD, with acceptable fusion rates and a low complication rate. However, TSIF is not recommended for revision reconstruction in ASD.
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Affiliation(s)
- Honglei Yi
- People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China.
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
| | - Hu Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Peirong Lian
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Xinran Ji
- Chinese PLA General Hospital, Beijing, China
| | | | | | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, 10021, USA
| | - Thomas Ross
- Hospital for Special Surgery, New York, NY, 10021, USA
| | - Venu M Nemani
- Hospital for Special Surgery, New York, NY, 10021, USA
| | - Hong Xia
- People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China.
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
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Shetty A, Kini AR, Chacko A, Sunil U, Vinod K, Geover L. Mini posterior lumbar interbody fusion with presacral screw stabilization in early lumbosacral instability. Indian J Orthop 2015; 49:278-83. [PMID: 26015626 PMCID: PMC4443408 DOI: 10.4103/0019-5413.156187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical options for the management of early lumbosacral spondylolisthesis and degenerative disc disease with instability vary from open lumbar interbody fusion with transpedicular fixation to a variety of minimal access fusion and fixation procedures. We have used a combination of micro discectomy and axial lumbosacral interbody fusion with presacral screw fixation to treat symptomatic patients with lumbosacral spondylolisthesis or lumbosacral degenerative disc disease, which needed surgical stabilization. This study describes the above technique along with analysis of results. MATERIALS AND METHODS Twelve patients with symptomatic lumbosacral (L5-S1) instability and degenerative lumbosacral disc disease were treated by micro discectomy and interbody fusion using presacral screw stabilization. Patients with history of bowel, bladder dysfunction and local anorectal diseases were excluded from this study. Postoperatively all patients were evaluated neurologically and radiologically for screw position, fusion and stability. Oswestry disability index was used to evaluate results. RESULTS We had nine females and three males with a mean age of 47.33 years (range 26-68 years). Postoperative assessment revealed three patients to have screw placed in anterior 1/4(th) of the 1(st) sacral body, in rest nine the screws were placed in the posterior 3/4(th) of sacral body. At 2 years followup, eight patients (67%) showed evidence of bridging trabeculae at bone graft site and none of the patients showed evidence of instability or implant failure. CONCLUSION Presacral screw fixation along with micro discectomy is an effective procedure to manage early symptomatic lumbosacral spondylolisthesis and degenerative disc disease with instability.
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Affiliation(s)
- Arjun Shetty
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India,Departments of Neurosurgery and Orthopaedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore, Karnataka, India
| | - Abhishek R Kini
- Departments of Neurosurgery and Orthopaedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore, Karnataka, India,Address for correspondence: Dr. Abhishek R Kini, Departments of Orthopaedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore - 575 002, Karnataka, India. E-mail:
| | - A Chacko
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Upadhyaya Sunil
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - K Vinod
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Lobo Geover
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
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Louwerens JKG, Groot D, van Duijvenbode DC, Spruit M. Alternative Surgical Strategy for AxiaLIF Pseudarthrosis: A Series of Three Case Reports. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 4:143-8. [PMID: 24436713 PMCID: PMC3836895 DOI: 10.1055/s-0033-1357357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 07/18/2013] [Indexed: 11/29/2022]
Abstract
Study Design Retrospective case series. Objective The objective of this study is to describe an alternative technique to attain interbody lumbar fusion in the event of pseudarthrosis after axial lumbar interbody fusion (AxiaLIF) and to assess its safety. Methods Three patients who suffered from pseudarthrosis after AxiaLIF underwent revision surgery with a DEVEX cage (DePuy Synthes, Raynham, MA, United States) through an anterior approach. We report technical details as well as clinical and radiological results at 12 months follow-up. Results Preoperative symptoms resolved in all cases. There were no perioperative complications. One patient had a deep venous thrombosis at postoperative day 9. A decrease in visual analog scale score for pain was observed, from 8.67 preoperatively to 2 postoperatively at final follow-up. Radiographic workup after 12 months showed no sign of implant failure or loosening, and fusion was obtained in all cases. Conclusion Anterior fusion with a DEVEX cage in front of a TranS1 screw (TranS1 screw, Inc., Wilmington, North Carolina, United States) for AxiaLIF pseudarthrosis is safe and effective.
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Affiliation(s)
- Jan K G Louwerens
- Centre for Orthopaedic Research, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Diederik Groot
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Woerden, The Netherlands
| | | | - Maarten Spruit
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
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Hofstetter CP, Shin B, Tsiouris AJ, Elowitz E, Härtl R. Radiographic and clinical outcome after 1- and 2-level transsacral axial interbody fusion. J Neurosurg Spine 2013; 19:454-63. [DOI: 10.3171/2013.6.spine12282] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The paracoccygeal approach allows for instrumentation of L5/S1 and L4/5 by using a transsacral rod (AxiaLIF; TransS1, Inc.). The authors analyzed clinical and radiographic outcomes of 1- or 2-level AxiaLIF procedures with focus on durability of the construct.
Methods
This was a retrospective study of 38 consecutive patients who underwent either 1-level (32 patients) or 2-level (6 patients) AxiaLIF procedures at the authors' institution. The Oswestry Disability Index (minimum clinically important difference [MCID] ≥ 12) and visual analog scale ([VAS]; MCID ≥ 3) scores were collected. Disc height and Cobb angles were measured on pre- and postoperative radiographs. Bony fusion was determined on CT scans or flexion/extension radiographs.
Results
Implantation of a transsacral rod allowed for intraoperative distraction of the L5/S1 intervertebral space and resulted in increased segmental lordosis postoperatively. At a mean follow-up time of 26.2 ± 2.4 months, however, graft subsidence (1.9 mm) abolished partial correction of segmental lordosis. Moreover, subsidence of the construct reduced L5/S1 lordosis in patients with 1-level AxiaLIF by 3.2° and L4–S1 lordosis in patients with 2-level procedures by 10.1° compared with preoperative values (p < 0.01). Loss of segmental lordosis predicted failure to improve VAS scores for back pain in the patient cohort (p < 0.05). Overall, surgical intervention led to modest symptomatic improvement; only 26.3% of patients achieved an MCID of the Oswestry Disability Index and 50% of patients an MCID of the VAS score for back pain. At last follow-up, 71.9% of L5/S1 levels demonstrated bony fusion (1-level AxiaLIF 80.8%, 2-level AxiaLIF 33.3%; p < 0.05), whereas none of the L4/5 levels in 2-level AxiaLIF fused. Five constructs developed pseudarthrosis and required surgical revision.
Conclusions
The AxiaLIF procedure constitutes a minimally invasive technique for L5/S1 instrumentation, with low perioperative morbidity. However, the axial rod provides inadequate long-term anterior column support, which leads to subsidence and loss of segmental lordosis. Modification of the transsacral technique to allow for placement of a solid interposition graft may counteract subsidence of the construct.
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Affiliation(s)
| | | | - Apostolos John Tsiouris
- 2Neuroradiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Manjila S, Singer J, Knudson K, Tomac AC, Hart DJ. Minimally invasive presacral retrieval of a failed AxiaLIF rod implant: technical note and illustrative cases. Spine J 2012. [PMID: 23199822 DOI: 10.1016/j.spinee.2012.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There are few reported cases of failed axial lumbar interbody fusion (AxiaLIF) in the existing neurosurgical literature, and an anecdotal case of open paramedian retroperitoneal approach to L5-S1 level for retrieval of AxiaLIF rod has been published. PURPOSE The object of this study is to illustrate a minimally invasive presacral rod retrieval technique in cases with failed AxiaLIF causing lumbosacral instability. STUDY DESIGN/SETTING Retrospective case series. METHODS A retrospective analysis of the initial 26 cases of AxiaLIF done at our institution was performed; two cases of failed AxiaLIF that required rod removal were identified for detailed study. Available literature on the minimally invasive presacral techniques for rod retrieval was researched, and the use of a novel rod retrieval device with an expanding hex tip is discussed. RESULTS Using a minimally invasive presacral approach through the previous surgical corridor, the authors were able to retrieve the AxiaLIF rod implant and then proceed with an alternative fusion technique. Both patients improved clinically and radiographically after revision. Removal of the presacral rod was not associated with vascular or bowel complications and required minimal operating room time with minimal blood loss. CONCLUSIONS To the authors' knowledge, this is the first report demonstrating the safety and efficacy of minimally invasive presacral approach for removal of AxiaLIF rods in patients with failed AxiaLIF. As the AxiaLIF procedure is rapidly gaining acceptance among spine surgeons, we can expect to see increasing numbers of failed procedures as well. Understanding options for revision strategies is important for surgeons considering the use of this technique.
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Affiliation(s)
- Sunil Manjila
- Department of Neurological Surgery, The Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Ave., HAN 5042, Cleveland, OH 44106, USA
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Boachie-Adjei O, Cho W, King AB. Axial lumbar interbody fusion (AxiaLIF) approach for adult scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 2:S225-31. [PMID: 22573050 DOI: 10.1007/s00586-012-2351-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 04/22/2012] [Indexed: 12/01/2022]
Abstract
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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