A clinical evaluation of two-level lumbar fusion using a combination of the AXIALIF and XLIF

Presented at SMISS 2009 Annual Conference
By William Blake Rodgers MD, FACS
With Edward Gerber MD, Jamie Patterson

Disclosures: William Blake Rodgers MD, FACS B; NuVasive. D; NuVasive, Alphatec. F; NuVasive., Edward Gerber MD None., Jamie Patterson None.

Summary:
38 patients underwent a combination of the XLIF and AxiaLIF minimally invasive approaches for fusion at L4-5 and L5-S1. Clinical and radiographic outcomes are reported and compared with traditional open approaches. The MIS combination results are comparable to – and the associated complications markedly less than – traditional open techniques.

Introduction:
Minimally invasive surgical fusion of the lumbar spine for multilevel disease presents special challenges at the lumbosacral junction. The combination of XLIF and AxiaLIF provides access to both L45 and L5S1. To our knowledge, no one has presented the results of this combination of procedures in comparison to traditional open fusion.

Methods:
Thirty-eight patients with a mean age of 59.6 years and a mean BMI of 30.4 received two-level fusions with an AxiaLIF at L5-S1 and XLIF at L4-L5 . The VAS scores, disc heights, and radiographic evaluations are presented at 3, 6, and 12 months post-operatively.

Results:
The mean VAS score in these patients pre-operatively was 8.6 and reached 2.8 at 12 months post-operatively, demonstrating a 5.8 point drop (67% reduction) in the VAS score. OR time averaged 150 minutes. There were no infections to date. Complications included a graft herniation requiring laminotomy at 3 mos, 1 wound problem requiring VAC, 1 urinary retention, 1 CHF requiring care in a rehab facility, and 1 postoperative transfusion. One patient required a laminectomy at 4 wks. We compared a similar group of 109 2-level open PLIF surgeries, in the MIS group the mean hemoglobin change of 2.08g; while hemoglobin change in PLIF patients averaged 3.1 (and 20% of PLIF patients were transfused). Hospital stay averaged 1.0 days for XLIFs and 3.2 days for PLIFs. In the PLIF group, there were 3 infections and 1 dural tear. While two MIS combination patients have required revision or reoperation (5%), there was a 10% reoperation rate in the PLIF cohort.

Conclusion:
Multilevel fusion at the lumbosacral junction can be achieved using a combination of XLIF and AxiaLIF procedures. The results are comparable to – and the associated complications markedly less than – traditional open techniques.