{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:24:10Z","timestamp":1794324250188,"version":"4.9.0"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2013,10]]},"abstract":"\n Object<\/jats:title>\n The paracoccygeal approach allows for instrumentation of L5\/S1 and L4\/5 by using a transsacral rod (AxiaLIF; TransS1, Inc.). The authors analyzed clinical and radiographic outcomes of 1- or 2-level AxiaLIF procedures with focus on durability of the construct.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a retrospective study of 38 consecutive patients who underwent either 1-level (32 patients) or 2-level (6 patients) AxiaLIF procedures at the authors' institution. The Oswestry Disability Index (minimum clinically important difference [MCID] \u2265 12) and visual analog scale ([VAS]; MCID \u2265 3) scores were collected. Disc height and Cobb angles were measured on pre- and postoperative radiographs. Bony fusion was determined on CT scans or flexion\/extension radiographs.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Implantation of a transsacral rod allowed for intraoperative distraction of the L5\/S1 intervertebral space and resulted in increased segmental lordosis postoperatively. At a mean follow-up time of 26.2 \u00b1 2.4 months, however, graft subsidence (1.9 mm) abolished partial correction of segmental lordosis. Moreover, subsidence of the construct reduced L5\/S1 lordosis in patients with 1-level AxiaLIF by 3.2\u00b0 and L4\u2013S1 lordosis in patients with 2-level procedures by 10.1\u00b0 compared with preoperative values (p < 0.01). Loss of segmental lordosis predicted failure to improve VAS scores for back pain in the patient cohort (p < 0.05). Overall, surgical intervention led to modest symptomatic improvement; only 26.3% of patients achieved an MCID of the Oswestry Disability Index and 50% of patients an MCID of the VAS score for back pain. At last follow-up, 71.9% of L5\/S1 levels demonstrated bony fusion (1-level AxiaLIF 80.8%, 2-level AxiaLIF 33.3%; p < 0.05), whereas none of the L4\/5 levels in 2-level AxiaLIF fused. Five constructs developed pseudarthrosis and required surgical revision.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The AxiaLIF procedure constitutes a minimally invasive technique for L5\/S1 instrumentation, with low perioperative morbidity. However, the axial rod provides inadequate long-term anterior column support, which leads to subsidence and loss of segmental lordosis. Modification of the transsacral technique to allow for placement of a solid interposition graft may counteract subsidence of the construct.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2013.6.spine12282","type":"journal-article","created":{"date-parts":[[2013,8,23]],"date-time":"2013-08-23T10:01:48Z","timestamp":1377252108000},"page":"454-463","source":"Crossref","is-referenced-by-count":21,"title":["Radiographic and clinical outcome after 1- and 2-level transsacral axial interbody fusion"],"prefix":"10.3171","volume":"19","author":[{"given":"Christoph P.","family":"Hofstetter","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Shin","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos John","family":"Tsiouris","sequence":"additional","affiliation":[{"name":"Neuroradiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Elowitz","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"H\u00e4rtl","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine12282","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1097\/00007632-199404150-00014","article-title":"Anular incision technique on the strength and multidirectional flexibility of the healing intervertebral disc","volume":"19","author":"Ahlgren","year":"1994"},{"key":"b2-spine12282","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/BSD.0b013e3180577242","article-title":"Biomechanical evaluation of paracoccygeal transsacral fixation","volume":"21","author":"Akesen","year":"2008"},{"issue":"3","key":"b3-spine12282","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E6","DOI":"10.3171\/2010.1.FOCUS09272","article-title":"Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis","volume":"28","author":"Anand","year":"2010"},{"key":"b4-spine12282","series-title":"Pain Physician","first-page":"237","article-title":"Treatment of intractable discogenic low back pain. 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