A pair of respected surgeons commend TranS1®’s AxiaLIF+® approach

Written by Staff | September 19, 2016 | Print  |

William D. Tobler, M.D. and Richard J. Nasca, MD, a pair of respected surgeons, collaborated to write a chapter on the unique paracoccygeal transsacral approach to the lumbosacral junction for interbody fusion in the fourth edition of “Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management.”

In the chapter, the surgeons give a detailed description of the unique operative technique used in the paracoccygeal transsacral approach to the lumbosacral junction for interbody fusion, also known as the presacral approach or axial lumbar interbody fusion (AxiaLIF+®). Instrumentation for this unique approach was developed by TranS1® and introduced to clinical trials over 10 years ago. Tobler and Nasca discussed preoperative considerations including the indications and contraindications for the approach, as well as the ideal candidate for the surgery.

 

The two surgeons discussed the comparative disadvantages of alternative fusion approaches, such as anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). In the chapter, Tobler and Nasca noted that the other approaches often carry greater risks than the transsacral approach (AxiaLIF+®).

 

The chapter also highlights the numerous advantages that this revolutionary surgical technique brings to both patients and physicians. The surgeons noted that the “paracoccygeal approach gives an advantageous access to the spine from an anterior approach,”1 and that, because of the minimally invasive nature of the approach, it “can be successfully completed in the outpatient/ambulatory setting,”2 an important feature for many patients and surgeons.

 

Another advantage of TranS1®’s foundational solution — the AxiaLIF+® system — is the biomechanical properties the device offers. The interbody device — created by TranS1® — “offers superior fixation”3 when compared to other interbody fusion approaches. The surgeons went on to further illustrate how pre sacral inter body fusion builds a strong foundation upon the patient’s L5-S1 joint.

 

Another noted advantage of AxiaLIF+® is its special ability to work for obese patients. AxiaLIF+® offers unique advantages for surgeons treating obese patients. The authors noted that “obesity does not affect the working depth to access the L5-S1 disc space.”4 When applying the alternative approaches, the working depth is made larger, increasing the difficulty of the operation and risks for technical errors. The surgeons went on to discuss potential complications that could arise using the presacral approach and how to avoid them, highlighting the uniqueness of the operation.

 

Finally, Tobler and Nasca surveyed the outcomes reported in literature during the timeframe since AxiaLIF+®’s inception. Since it’s introduction, the approach “has been performed in about 14,000 procedures and is now well understood in terms of risk and outcome profile.”5 The foundational AxiaLIF+® solution is minimally invasive, reduces blood loss, inpatient stay and inter operative time while achieving a 94 percent fusion rate in a multicenter retrospective review.6 Overall, the AxiaLIF+® procedure exhibited higher fusion rates and lower complication rates than other approaches.7

 

Unfortunately, many surgeons lack familiarity with both the tools needed and the surgical corridor used in this approach. As a result, Tobler and Nasca underlined the importance of education surrounding the technique and anatomy associated with this operation, as each aspect of this approach is unlike any other. As more surgeons are educated on this foundational solution, it is more likely they will adopt this unique approach.

 

Inclusion of the AxiaLIF+® approach in “Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management” confirms the legitimacy of the approach in the eyes of the spine surgeon community. The text delivers the most up-to-date information available on every aspect of spine surgery — including the revolutionary AxiaLIF+® approach.

 

1. William D. Tobler, "Paracoccygeal Transsacral Approach to the Lumbosacral Junction for Interbody Fusion," in Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management, by Richard J. Nasca, Fourth ed. (Philadelphia, PA: Elsevier, 2017)

 

2. William D. Tobler, "Paracoccygeal Transsacral Approach to the Lumbosacral Junction for Interbody Fusion," in Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management, by Richard J. Nasca, Fourth ed. (Philadelphia, PA: Elsevier, 2017).

 

3. William D. Tobler, "Paracoccygeal Transsacral Approach to the Lumbosacral Junction for Interbody Fusion," in Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management, by Richard J. Nasca, Fourth ed. (Philadelphia, PA: Elsevier, 2017).

 

4. William D. Tobler, "Paracoccygeal Transsacral Approach to the Lumbosacral Junction for Interbody Fusion," in Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management, by Richard J. Nasca, Fourth ed. (Philadelphia, PA: Elsevier, 2017).

 

5. William D. Tobler, "Paracoccygeal Transsacral Approach to the Lumbosacral Junction for Interbody Fusion," in Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management, by Richard J. Nasca, Fourth ed. (Philadelphia, PA: Elsevier, 2017).

 

6. William D. Tobler, "Paracoccygeal Transsacral Approach to the Lumbosacral Junction for Interbody Fusion," in Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management, by Richard J. Nasca, Fourth ed. (Philadelphia, PA: Elsevier, 2017).

 

7. William D. Tobler, "Paracoccygeal Transsacral Approach to the Lumbosacral Junction for Interbody Fusion," in Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management, by Richard J. Nasca, Fourth ed. (Philadelphia, PA: Elsevier, 2017).

 

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