Complications following two-level axial lumbar interbody fusion

July 20, 2012

Surgeons from the Instituto de Patologia da Coluna in Sao Paulo, Brazil have found that an innovative minimally invasive surgical procedure performed to achieve two-level axial lumbar interbody fusion produced immediate successful results, but within 2 years complications set in, making the procedure far less desirable. Findings of this study are reported in the article "Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up. Clinical article," by Luis Marchi, Leonardo Oliveira, Etevaldo Coutinho, M.D., and Luiz Pimenta, M.D., Ph.D., published this week online in the Journal of Neurosurgery: Spine.

The report stems from a prospective, nonrandomized single-center study of 27 patients who underwent presacral axial (AxiaLIF [TranS1, Inc.]) at two levels: L4-5 and L5-S1. Surgery was performed to correct symptomatic lumbosacral , degenerative low-grade , or failed-back surgery syndrome. The patients suffered from low-back pain, radicular , or both. Outcomes of the procedures were assessed on the basis of imaging studies (radiographs and CT scans) and patient-reported questionnaires (assessments based on applying a visual analog pain scale and the ).

No intraoperative complications were related to the surgical approach. Significant clinical improvement was apparent following surgery. By the 2-year follow-up, patients reported a 50% reduction in back pain and a 40% reduction in disability.

Outcomes of the procedure documented by imaging studies, however, were not as promising. The surgical goals of disc height/foramen space distraction, lordosis gain/maintenance, and spine stabilization appeared to be achieved shortly after surgery; however, as time progressed these achievements were lost and in some cases outcomes were worse than before surgery. In addition, complications abounded: screw breakage (14.8% of patients), rod detachment (11.1%), cephalic rod migration (24%), and radiolucency around the transsacral rod (52%). At 24 months postoperatively, solid spinal fusion had been obtained at both L4-5 and L5-S1 in only 2 patients (8%); fusion had been obtained at L4-5 in 20% of patients and at L5-S1 in 24% of patients.

The authors point out that the AxiaLIF approach has already proved to be effective for creating fusion at one level: L5-S1. In doing this it offers advantages over other techniques because it does not damage the annulus fibrosus or the anterior or posterior longitudinal ligaments. The application of the AxiaLIF technique to two spinal levels is relatively new. In this small study, application of the technique for this purpose was not effective and was accompanied by many complications. The authors suggest that additional studies should be performed to assess the anatomical and application limitations of the technique.

Explore further: Study tests unilateral versus bilateral lumbar fusion

More information: Marchi L, Oliveira L, Coutinho E, Pimenta L. Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up. Clinical article, Journal of Neurosurgery: Spine, published online July 17, 2012, ahead of print; DOI: 10.3171/2012.6.SPINE11915

Related Stories

Study tests unilateral versus bilateral lumbar fusion

April 9, 2012

(HealthDay) -- For patients with degenerative lumbar diseases, the unilateral pedicle screw (PS) instrumented transforaminal lumbar interbody fusion (TLIF) procedure results in shorter operative time, less blood loss, and ...

Instrumented spinal fusion method impacts infection rate

May 21, 2012

(HealthDay) -- For patients who undergo instrumented spinal fusion, the rates of infection are higher among those who receive posterior lumbar interbody fusion compared with those who receive posterior or posterolateral fusion, ...

Spondylolisthesis linked to spinous process fractures

June 2, 2012

(HealthDay) -- There is a strong association between degenerative spondylolisthesis and spinous process fracture in patients undergoing interspinous process spacer (IPS) surgery, according to a study published online May ...

Lateral transpsoas approach difficult in lumbarized sacra

July 10, 2012

(HealthDay) -- In patients with lumbarized sacra, a lateral transpsoas surgical approach to the L5-6 disc space can be managed with appropriate preoperative planning, including axial magnetic resonance imaging (MRI) and advanced ...

Recommended for you

Outside the body, a heart beats via life-saving system

September 1, 2015

(Medical Xpress)—A system that enables heart transplants involving hearts that stopped beating in the donor's body continues to save lives. The Organ Care System (OCS) has been used in UK hospitals with good results.

A recipe for long-lasting livers

April 22, 2015

People waiting for organ transplants may soon have higher hopes of getting the help that they need in time. Researchers at the RIKEN Center for Developmental Biology have developed a new technique that extends the time that ...

Surgeon to offer ideas on a way to do human head transplants

February 26, 2015

Sergio Canavero of the Turin Advanced Neuromodulation Group has made it known that he intends to announce at this summer's American Academy of Neurological and Orthopedic Surgeons meeting, that he believes he has put together ...

New tool helps guide brain cancer surgery

July 3, 2014

A tool to help brain surgeons test and more precisely remove cancerous tissue was successfully used during surgery, according to a Purdue University and Brigham and Women's Hospital study.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.