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Peer-reviewedCC BY-NC-NDGlobal spine journal

AO Spine Clinical Practice Recommendations for Interbody Fusion at the Lumbo-Sacral Junction.

  • Christopher T Martin1
  • Luca Ambrosio2
  • Juan P Cabrera Cousiño3
  • David Gendelberg4
  • Waeel Hamouda5,6
  • Hai V Le7
  • Mark Feger8
  • Sathish Muthu9,10
  • Mohamed Sarraj11
  • Rachel Bratescu12
  • S Tim Yoon13
  • Javad Tavakoli14,15
10 more authors
  • Stipe Corluka16
  • Uruj Zehra17
  • Vadim Byvaltsev18
  • Ashish Diwan19
  • Patrick C Hsieh20
  • Amit Jain21
  • Gianluca Vadalà2
  • Samuel K Cho22
  • Charles G Fischer23
  • AO Spine Knowledge Forum Degenerative
23 affiliations
  1. 1Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
  2. 2Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
  3. 3Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile.
  4. 4Department of Orthopaedic Surgery, University of California San Francisco, Freemont, CA, USA.
  5. 5Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research and Teaching Hospitals, Cairo University, Cairo, Egypt.
  6. 6Neurological & Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia.
  7. 7Department of Orthopaedic Surgery, University of California Davis, Davis, CA, USA.
  8. 8Department of Orthopaedic Surgery & Rehabilitation, University of Arkansas for Medical Sciences, North Little Rock, AR, USA.
  9. 9Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India.
  10. 10Central Research Laboratory, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation (Deemed to be University)Puducherry, India.
  11. 11Waterloo Regional Health Network, Kitchener, ON, Canada.
  12. 12Spine and Pain Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
  13. 13Department of Orthopaedics, Emory University, Atlanta, GA, USA.
  14. 14Centre for Health Technologies, School of Biomedical Engineering, University of Technology Sydney, Australia.
  15. 15SpineLabs, St George and Sutherland Clinical School, The University of New South Wales, Sydney, Australia.
  16. 16Spinal Surgery Division of the Department of Traumatology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia.
  17. 17Department of Anatomy, University of Health Sciences, Lahore, Pakistan.
  18. 18Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.
  19. 19Department of Orthopaedic Surgery, St George Hospital Campus, Kogarah, NSW, Australia.
  20. 20Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
  21. 21Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
  22. 22Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  23. 23Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.
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Abstract

Study DesignLiterature review with clinical recommendation.ObjectiveProvide a concise curation of recent literature in interbody fusions at the lumbo-sacral junction.MethodsLiterature is graded based on the integration of scientific methodology and expert opinion.ResultsArticle 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.ConclusionsSegmental 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.

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Cite

BibTeXRIS
BibTeX
@article{martin2026spine,
  title = {{AO Spine Clinical Practice Recommendations for Interbody Fusion at the Lumbo-Sacral Junction.}},
  author = {Christopher T Martin and Luca Ambrosio and Juan P Cabrera Cousiño and David Gendelberg and Waeel Hamouda and Hai V Le and Mark Feger and Sathish Muthu and Mohamed Sarraj and Rachel Bratescu and S Tim Yoon and Javad Tavakoli and Stipe Corluka and Uruj Zehra and Vadim Byvaltsev and Ashish Diwan and Patrick C Hsieh and Amit Jain and Gianluca Vadalà and Samuel K Cho and Charles G Fischer and AO Spine Knowledge Forum Degenerative},
  journal = {Global spine journal},
  year = {2026},
  month = oct,
  doi = {10.1177/21925682261492226},
  url = {https://europepmc.org/article/MED/42925017},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - AO Spine Clinical Practice Recommendations for Interbody Fusion at the Lumbo-Sacral Junction.
AU  - Christopher T Martin
AU  - Luca Ambrosio
AU  - Juan P Cabrera Cousiño
AU  - David Gendelberg
AU  - Waeel Hamouda
AU  - Hai V Le
AU  - Mark Feger
AU  - Sathish Muthu
AU  - Mohamed Sarraj
AU  - Rachel Bratescu
AU  - S Tim Yoon
AU  - Javad Tavakoli
AU  - Stipe Corluka
AU  - Uruj Zehra
AU  - Vadim Byvaltsev
AU  - Ashish Diwan
AU  - Patrick C Hsieh
AU  - Amit Jain
AU  - Gianluca Vadalà
AU  - Samuel K Cho
AU  - Charles G Fischer
AU  - AO Spine Knowledge Forum Degenerative
PY  - 2026
DA  - 2026/10/23
JO  - Global spine journal
DO  - 10.1177/21925682261492226
UR  - https://europepmc.org/article/MED/42925017
AB  - Study DesignLiterature review with clinical recommendation.ObjectiveProvide a concise curation of recent literature in interbody fusions at the lumbo-sacral junction.MethodsLiterature is graded based on the integration of scientific methodology and expert opinion.ResultsArticle 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.ConclusionsSegmental 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.
SN  - 2192-5682
SN  - 2192-5690
ER  -