Axial Lumber Interbody Fusion as an Alternative "Salvage" Approach to Lumbosacral Fixation: A Case Series

Lumbar interbody fusion is commonly performed to improve spinal stability in the context of degenerative, traumatic, and deformity-related pathologies. The axial lumbar interbody fusion (AxiaLIF) technique, also known as presacral interbody arthrodesis, is the only presacral interbody fusion technique approved by the US Food and Drug Administration. It is a rarely utilized approach to interbody fusion that aims to achieve fusion across L4 to L5 and/or L5 to S1 levels, which are the most susceptible to pseudoarthrosis and hardware failure. This case series describes the utility of the AxiaLIF procedure as a salvage approach when traditional interbody fusion techniques pose significant risks or are not feasible due to rare patient-specific factors.

All identifiable cases of the AxiaLIF procedure performed at a single, academic medical center were reviewed. Operative data were collected and each case presentation is described in detail.

Six patients underwent AxiaLIF between July 2010 and May 2022. Indications for AxiaLIF as a salvage approach included hardware failure with a significant risk of recurrence with traditional revision techniques; a lack of segmental fixation at the distal end of the spinal construct; avoiding extensive tissue disruption in the setting of staged realignment surgery or previously compromised tissue; and comorbidities such as muscular dystrophy, abdominal hernias, and severe obesity. Two patients were fused solely across the L5 to S1 level, and 4 patients were fused from L4 to S1. The mean operative time, estimated blood loss, time under fluoroscopy, complications, and follow-up were noted.

This case series introduces the utility of AxiaLIF as a salvage approach. We believe the AxiaLIF procedure may be a valuable alternative to traditional lumbar interbody fusion in salvage situations when traditional techniques are not feasible or pose significant risk to the patient. In such situations, surgeon awareness of this approach has the potential to improve patient outcomes and safety.

AxiaLIF, as a salvage approach, has the potential to improve patient outcomes safely when other surgical options pose significant risk or are not feasible.