Tender et al. Journal of Medical Case Reports 2011, 5:454 http://www.jmedicalcasereports.com/content/5/1/454 C A S E R E P O R T Percutaneous pedicle screw reduction and axial presacral lumbar interbody fusion for treatment of lumbosacral spondylolisthesis: A case series Gabriel C Tender1, Larry E Miller2,3 and Jon E Block3* Abstract Introduction: Traditional surgical management of lumbosacral spondylolisthesis is technically challenging and is associated with significant complications. The advent of minimally invasive surgical techniques offers patients treatment alternatives with lower operative morbidity risk. The combination of percutaneous pedicle screw reduction and an axial presacral approach for lumbosacral discectomy and fusion offers an alternative procedure for the surgical management of low-grade lumbosacral spondylolisthesis. Case presentation: Three patients who had L5-S1 grade 2 spondylolisthesis and who presented with axial pain and lumbar radiculopathy were treated with a minimally invasive surgical technique. The patients-a 51-year-old woman and two men (ages 46 and 50)-were Caucasian. Under fluoroscopic guidance, spondylolisthesis was reduced with a percutaneous pedicle screw system, resulting in interspace distraction. Then, an axial presacral approach with the AxiaLIF System (TranS1, Inc., Wilmington, NC, USA) was used to perform the discectomy and anterior fixation. Once the axial rod was engaged in the L5 vertebral body, further distraction of the spinal interspace was made possible by partially loosening the pedicle screw caps, advancing the AxiaLIF rod to its final position in the vertebrae, and retightening the screw caps. The operative time ranged from 173 to 323 minutes, and blood loss was minimal (50 mL). Indirect foraminal decompression and adequate fixation were achieved in all cases. All patients were ambulatory after surgery and reported relief from pain and resolution of radicular symptoms. No perioperative complications were reported, and patients were discharged in two to three days. Fusion was demonstrated radiographically in all patients at one-year follow-up. Conclusions: Percutaneous pedicle screw reduction combined with axial presacral lumbar interbody fusion offers a promising and minimally invasive alternative for the management of lumbosacral spondylolisthesis. JOURNAL OF MEDICAL CASE REPORTS Open Access Introduction Patients with intractable low back pain or radiculopathy (or both) resulting from lumbar or lumbosacral spondy- lolisthesis benefit from surgical intervention [1,2]. Stan- dard surgical protocols use a midline incision, posterior decompressive laminectomy, and posterolateral or inter- body fusion (or both) [1]. Minimally invasive spinal sur- gery techniques have recently allowed the surgeon to obtain comparable clinical and radiographic results with less iatrogenic soft tissue injury and minimal blood loss. These techniques use a tubular retractor and the * Correspondence: jonblock@jonblockphd.com 3Jon E. Block, PhD, Inc., 2210 Jackson Street, Suite 401, San Francisco, CA 94115, USA Full list of author information is available at the end of the article transforaminal approach, usually augmented with percu- taneous placement of pedicle screw systems [3,4]. The recently developed AxiaLIF System (TranS1, Inc., Wil- mington, NC, USA) uses the presacral ‘safe zone’ to pro- vide access to the L5-S1 or L4-5, L5-S1 interspaces for discectomy and fusion and achieves fusion rates similar to those of the transforaminal approach but with less risk of nerve injury [5]. The purpose of this case series was to describe an alternative technique for the treat- ment of lumbosacral spondylolisthesis. This alternative combines a percutaneous pedicle screw reduction sys- tem and the AxiaLIF technique. © 2011 Tender et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.