Secondary Logo

Institutional members access full text with Ovid®

Presacral Approach for L5-S1 Fusion

Durrani, Atiq MD*; Mistur, Rachel MS*; Shanti, Nael MD*

doi: 10.1097/BTO.0b013e31822ce192

Axial lumbar interbody fusion (AxiaLIF; Trans1 Inc., Wilmington, NC) offers a presacral approach to L4-L5 and L5-S1 fusions. This minimally invasive procedure has been successfully used for the treatment of degenerative disc disease, spondylolisthesis, and spinal stenosis, among other conditions. Open anterior lumbar interbody fusion (ALIF) procedures are associated with significant morbidity and vascular and visceral complications. Open ALIF requires disruption of the annulus and sectioning of the anterior longitudinal ligament, which can weaken the motion segment. Comparison of several large-scale AxiaLIF studies with results from open fusion techniques show comparable fusion rates and clinical outcomes at 2-year follow-up. However, AxiaLIF patients show reduced estimated blood loss, hospital stay, complications, and overall decreased morbidity when compared with patients who undergo open fusion. The studies cited in this review support the safety of this presacral annulus-sparing approach and demonstrate low incidence of vascular and visceral injuries. Our clinical experience with this procedure confirms these findings. Overall, this minimally invasive, alternative approach for L4-L5 and L5-S1 fusion appears to offer several potential advantages over open techniques for lumbar fusion in appropriate patient candidates.

*Center for Advanced Spine Technologies, Cincinnati, OH

Atiq Durrani and Rachel Mistur, are paid consultants for Trans1 Inc.

Address correspondence and reprint requests to Atiq Durrani, MD, Center for Advanced Spine Technologies, 4555 Lake Forest Drive, Cincinnati, OH 45242. E-mail:

Received June 27, 2011

Accepted July 8, 2011

© 2011 Lippincott Williams & Wilkins, Inc.