The purpose of this article is to report results and complications of axiaLIF 2-level with a minimum of 24-month follow-up.

     Twenty-seven patients underwent AxiaLIF surgery for L4-L5 and L5-S1 fusion and were eligible for enrollment.

     This is a prospective, non-randomized, single-center study. Clinical outcomes were collected with VAS for back and leg symptoms and with ODI, preoperatively and postoperatively at 1 week, 6 weeks, 3 months, 6 months, 12 months and annually. Radiographic parameters such as disc height, segmental lordosis and bone fusion were analyzed with x-rays and computed tomography. Complications and revision surgeries were also recorded. The minimum follow-up was 24 months (up to 72 months).

     There were no intraoperative complications. One major complication was observed: a patient evolved with septicemia. Clinical questionnaires scores showed overall improvement in pain and in physical function. During follow-up were observed complications in the construction: screw breakage (14.8%), proximal/distal transsacral rod detachment (11.1%), radiolucency around transsacral rod (52%) and cephalic rod migration (24%). Disc height gain was testified early after surgery, but at 24-month follow-up the disc space was seen to be diminished in comparison to preoperative status. Compared to preop values, after 24 months the studied group had experienced lost in segmental lordosis. Only 22% of total treated levels were considered to have solid fusion at 24-month radiological evaluation.

     This is a retrospective study.

     Cases undergoing axiaLIF 2-level have experienced satisfactory short-term clinical outcomes. Yet vast radiological complications compromised surgery goals after 24 months.

     Additional studies are required to better understand 2-level indication for this technique.