Axial lumbosacral interbody fusion (LIF; also called presacral, transsacral, or paracoccygeal interbody fusion) is a minimally invasive technique designed to provide anterior access to the L4-S1 disc spaces for interbody fusion while minimizing damage to muscular, ligamentous, neural, and vascular structures. It is performed under fluoroscopic guidance.
Axial lumbosacral interbody fusion is considered investigational.
North American Spine Society
The North American Spine Society published guidelines on the treatment of degenerative spondylolisthesis in 2014. The Society gave a grade B recommendation for surgical decompression with fusion in individuals with spinal stenosis and spondylolisthesis. The guidelines discussed posterolateral fusion, 360º fusion, and minimally invasive fusion; it did not address axial lumbosacral interbody fusion.
National Institute for Health and Care Excellence
The National Institute for Health and Care Excellence (NICE) provided guidance on transaxial interbody fusion in the lumbosacral spine in 2011. The guidance stated that current evidence on the efficacy of transaxial interbody lumbosacral fusion is “limited in quantity but shows symptom relief in the short term in some individuals. Evidence on safety shows that there is a risk of rectal perforation.” The Institute encouraged “further research into transaxial interbody lumbosacral fusion. Research outcomes should include fusion rates, pain and functional scores, quality of life measures, and the frequency of both early and late complications.”
In July 2018, the NICE guidance was updated and replaced by evidence-based recommendations on transaxialinter body lumbosacral fusion for low back pain in adults. The recommendation, based on a literature review conducted in December 2017, states, “Evidence on the safety of transaxialinter body lumbosacral fusion for severe chronic low back pain shows that there are serious but well-recognized complications. Evidence on efficacy is adequate in quality and quantity. Therefore, this procedure may be used provided that standard arrangements are in place for clinical governance, consent and audit. This procedure should only be done by a surgeon with specific training in the procedure, who should carry out their initial procedures with an experienced mentor.”