Axial interbody arthrodesis of the L5-S1 segment: a systematic review of the literature

J Neurosurg Spine. 2015 Sep;23(3):314-9. doi: 10.3171/2015.1.SPINE14900. Epub 2015 Jun 12.


Object: The object of this study was to determine the fusion rate and safety profile of an axial interbody arthrodesis of the L5-S1 motion segment.

Methods: A systematic search of MEDLINE was conducted for literature published between January 1, 2000, and August 17, 2014. All peer-reviewed articles related to the fusion rate of L5-S1 and the safety profile of an axial interbody arthrodesis were evaluated.

Results: Seventy-four articles were identified, but only 15 (13 case series and 2 retrospective cohort studies) met the study inclusion criteria. The overall pseudarthrosis rate at L5-S1 was 6.9%, and the rate of all other complications was 12.9%. A total of 14.4% of patients required additional surgery, and the infection rate was 5.4%. Deformity studies reported a significantly increased rate of complications (46.3%), and prospectively collected data demonstrated significantly higher complication (36.8%) and revision (22.6%) rates. Lastly, studies with a conflict of interest reported lower complication rates (12.4%).

Conclusions: A systematic review of the literature indicates that an axial interbody fusion performed at the lumbosacral junction is associated with a high fusion rate (93.15%) and an acceptable complication rate (12.90%). However, these results are based mainly on retrospective case series by authors with a conflict of interest. The limited prospective data available indicate that the actual fusion rate may be lower and the complication rate may be higher than currently reported.

Keywords: ALIF = anterior lumbar interbody fusion; GLMM = generalized linear mixed model; S1 fusion; lumbar; axial interbody arthrodesis; systematic review; Axialif; L5; rhBMP-2 = recombinant human bone morphogenetic protein 2.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Lumbar Vertebrae / surgery*
  • Reoperation
  • Sacrum / surgery*
  • Spinal Fusion / adverse effects
  • Spinal Fusion / methods*
  • Treatment Outcome