Safety and effectiveness of retrorectal presacral approach for lumbosacral axial instrumentation. A clinical study.

This prospective study aimed to quantify the risks and complications associated with AxiaLIF in a series of 29 patients. AxiaLIF is a fusion technique using a percutaneous retrorectal, presacral corridor approach to access the L5-S1 and L4-L5 intervertebral spaces transaxially, through the body of S1 and L5 vertebrae. The fusion rate in the present series was 92% and the reported results ranged from 68% to 100%. The only serious complication in the authors' series was one presacral haematoma (1/29, or 35%). Symptomatic subsidence occurred in the stand alone group, resulting in foraminal stenosis and radiculopathy in two patients (7%) and back pain in one (3.5%). Painful radiolucent halo around the rod was noted in a spondylolytic case (1/29, or 3.5%); it resolved after transpedicular instrumentation. AxiaLIF is a novel truly minimally invasive technique not requiring blood transfusion and can be safely performed as a day surgery. Retroperitoneal haematoma, ureteral and vascular injuries can be avoided by respecting the regional anatomical landmarks as guided by accurate fluoroscopy. Only expanding haematomas may have to be drained. Bowel perforation can be prevented by gently sweeping away the rectum from the sacrum before inserting the guide probe.