AO Spine Clinical Practice Recommendations for Interbody Fusion at the Lumbo-Sacral Junction
Year: 2026
Type: article
Abstract: Study Design Literature review with clinical recommendation. Objective Provide a concise curation of recent literature in interbody fusions at the lumbo-sacral junction. Methods Literature is graded based on the integration of scientific methodology and expert opinion. Results Article 1: ALIF with and without posterior instrumentation, Conditional recommendation: ALIF is comparable to 360 fusions in well selected patients. Article 2: ALIF+Perc Screws v. MIS TLIF at L5-S1, Conditional recommendation: use ALIF in cases where higher lordosis correction is needed, Article 3: L4-S1 ALIF v. TLIF with grade 1-2 osteotomy, Conditional recommendation: use ALIF in cases where higher lordosis correction is needed. Article 4: The Deformity TLIF, Conditional recommendation: additional corrective maneuvers (grade 2 osteotomy, rod compression, anterior placement of the cage in the disc, hinged motorized operative table) can aid in achieving lordosis correction. Article 5: Revision rates in isthmic spondylolisthesis, Conditional recommendation: interbody use and 360 fusions decrease revision rates. Article 6: ALIF v. TLIF for isthmic spondylolisthesis , Conditional recommendation: use ALIF+Perc screws when an anterior approach is feasible. Conclusions Segmental alignment matters, even in short segment constructs. Patients who require large magnitude correction are likely better served with an anterior approach as the literature consistently shows greater lordosis change with ALIF compared to TLIF. Appropriate lordosis is possible with TLIF, but surgeons must implement additional technical steps. For anterior fusions, supplemental fixation reduces the nonunion risk, but may not be necessary in a narrow subset of stable listhesis with good bone quality.
Source: Global Spine Journal
Authors: Christopher T. Martin, Luca Ambrosio, Juan P. Cabrera Cousiño, David Gendelberg, Waeel Hamouda, Hai V. Le, Mark Feger, Sathish Muthu, Mohamed Sarraj, Rachel Bratescu, S. Tim Yoon, Javad Tavakoli, Stipe Corluka, Uruj Zehra, Vadim Byvaltsev, Ashish Diwan, Patrick C. Hsieh, Amit Jain, Gianluca Vadalà, Samuel K. Cho, Charles G. Fischer, AO Spine Knowledge Forum Degenerative
Institutions: University of Minnesota, Università Campus Bio-Medico, Hospital Regional de Concepción, University of California, San Francisco, Cairo University, Security Forces Hospital, University of California, Davis, University of Arkansas for Medical Sciences, Vinayaka Missions University, Aarupadai Veedu Medical College & Hospital, Orthopaedic Research Group, Regional Municipality of Waterloo, George Washington University, Emory University, University of Technology Sydney, UNSW Sydney, Sisters of Charity Hospital, Sağlık Bilimleri Üniversitesi, Irkutsk State Medical University, University of Southern California, Johns Hopkins University, Icahn School of Medicine at Mount Sinai, University of British Columbia, Vancouver General Hospital
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,650
OpenAlex ID: W7223398587