Author(s)

Alfonso Vega Sosa¹, Sergio Ivan Reyna Heredia², Apolinar De la Luz Laguna², Ivanka Berenice Moreno Villa¹, Marlene de la Peña Gutiérrez³, Ramiro López Elizalde², Cuauhtémoc Gil Ortiz², Andres Jaime Aguirre², Ivan Alejandro Mendez Guerrero¹, Edwin Rolando Sanchez Vallejo¹, Alejandra Grisel Mendoza Zuñiga², Ricardo Cazares Mejía¹, Carlos Erosa Velázquez¹

¹Universidad Nacional Autónoma de México, Mexico City, Mexico.
²Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico.
³Centro Médico Naval, Mexico City, Mexico.

Introduction: Since the earliest description of spinal fusion in 1911 and later by Dr. Fred H. Albee, it has become one of the most commonly performed procedures by orthopedist and neurosurgeons. The spinal fusion is now used to treat a variety of indications, such as traumatic injuries, deformities, primary and secondary tumors, infections and degenerative conditions of the spine. The risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (Axia-LIF) is a minimal invasive technique which uses the retroperitoneumpresacral anatomical corridor to fuse the lumbar vertebral bodies L4-L5-S1 avoiding manipulation of the annular ligament, paravertebral muscles and facet joints. Methods: In this retrospective series, we report all the cases made in the Centro Medico Naval in México City in two years. A total of eleven patients with degenerative disc disease and spondylolisthesis underwent Axia-LIF one or two level systems with a 36 months clinical and radiographic follow-up. The outcomes included Oswestry Disability Index (ODI) score and leg/back pain severity. Radiographic outcome was evaluated with dynamics and orthogonal x-ray, as well as lumbosacral tomography scan to evaluate fusion status. Results: Nine patients underwent Axia-LIF one level system (L5-S1) and the rest two levels system (L4-S1). Ten patients were fixated with transpedicular percutaneous screws and one with facets joints screws. No intraoperative complications were reported. The mean back pain severity improved 57% in 12 months, and the mean leg pain severity improved 50% in the same time (P < 0.001). Mean ODI scores improved 58%, from 60% ± 16% at baseline to 25% ± 8% at twelve months (P < 0.001). At one year, a patient developed pseudoarthrosis that required posterolateral arthrodesis with transpedicular percutaneous screws. At 36 months monitoring, 100% patients presented a total interbody fusion in the tomography scans. At final follow-up, mean ODI score improved 73% (16% ± 5%; P < 0.001). Conclusion: The Axial Lumbar Interbody Fusion has demonstrated to be a safe treatment for the degenerative disc disease L5-S1 and L4-S1. The patients who underwent one or two level Axia-LIF showed an improvement in ODI and back/leg pain severity scores, with no intraoperative complications. The use of this technique and its indications are still in controversy; nevertheless, its use has increased as for pathologies such as spondylitis, scoliosis, patients with residual pain with previous surgeries. We recommended complementary pedicular fixation to avoid complications and improved interbody fusion.

Spine Surgery, Axial-LIF Procedure, Axial-LIF, CMN 20 de Noviembre, Spinal Fusion, Centro Médico Naval

Sosa, A. , Heredia, S. , Laguna, A. , Villa, I. , Gutiérrez, M. , Elizalde, R. , Ortiz, C. , Aguirre, A. , Guerrero, I. , Vallejo, E. , Zuñiga, A. , Mejía, R. and Velázquez, C. (2023) Case Series of 11 Patients Operated with Axial-LIF Technique in a Single Center in Mexico. Open Journal of Modern Neurosurgery, 13, 129-136. doi: 10.4236/ojmn.2023.133015.