Efficacy and safety of minimally invasive axial presacral L5-S1 interbody fusion in the treatment of lumbosacral spine pathology: a retrospective clinical and radiographic analysis Minimally invasive axial presacral L5-S1 interbody fusion

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Massimo Balsano
Mauro Spina https://orcid.org/0000-0003-0079-021X
Sara Segalla
Da Broi Michele
Carlo Doria


degenerative disc disease, axiaLIF, pre-sacral approach, fusion L5/S1



The surgical treatment of degenerative disc disease L5-S1 is considerably controversial. The purpose of this study was to evaluate the radiographic and clinical results of patients treated with AxiaLif® Technique (AxiaLif®, AMSGroup, Italy) using a minimally invasive pre-sacral approach.


From 2013 to 2018 a total of 52 patients have been treated (12 M, 40 F; mean age 46.3 years). Diagnosis included L5 isthmic spondylolisthesis low-grade dysplasia, primary and secondary degenerative disc disease. 43 patients have been followed for at least 2 years. Fusion assessment was based on plain radiographs and Brantigan fusion criteria at 1, 6, 12 and 24 months after surgery. All patients completed the VAS and ODI at baseline through last follow-up.


Clinical results showed good pain resolution. VAS back demonstrated an average reduction over baseline of 50%, 57%, 71%, 77% at 3, 6, 12 and 24 months, respectively (p<0.001). ODI demonstrated an average reduction over baseline of 38%, 51%, 67%, and 72% at the same time points (p<0.001). Complete fusion was demonstrated in 65% of cases, 30% partial fusion and 5% in the absence of bony bridges visible radiographically. We had two major complications, as 1 retroperitoneal hematoma and 1 spondylodiscitis, and one minor complication, as a superficial infection of the surgical wound.


The surgical treatment of degenerative disc disease at L5-S1 with minimally invasive technique Axialif showed good radiographic and clinical outcomes with an acceptable rate of complications. Moreover, shorter hospitalization and faster functional recovery are adding factors to choice this technique.


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