Abstract

Introduction: The L5-S1 disc space can be a challenging level for spinal fusion given the lumbar and sacral transitional anatomy. Technology and innovation however have combined in easing this task. In select patients, we have found that a minimally-invasive, viable, and often preferable option is to combine a lateral retroperitoneal trans-psoas approach (XLIF) with a posterior paracoccygeal trans-S1 approach (AxiaLIF). This construct can then be fortified with percutaneous pedicle screw instrumentation. Methods: We performed a retrospective chart review of 5 patients in particular who presented with degenerative disc disease of the lumbo-sacral spine. All patients failed non-operative management, demonstrated chronic-progressive symptoms consistent with imaging. We performed a combined multilevel XLIF followed by an AxiLIF and percutaneous pedicle screw instrumented fusion. Results: All patients did well radiographically and clinically. They experience no significant blood loss, did not require blood transfusions, were up and out of bed post-op day 1 and went home by postop day 3. Postoperative imaging demonstrates a biomechanically sound construct. Patients reported immediate relief of radiculopathy and significant improvement of their low back pain. Conclusions: This combination of the XLIF and AxiaLIF techniques has allowed a surgeon to perform minimally-invasive surgical techniques while alleviating patient suffering, achieving a stable construct, and avoiding significant potential complications from traditional approaches.