Early Experiences With Single-Position Prone Lateral Lumbar Interbody Fusion: Safety and Outcomes

Abstract

Background:

Performing lateral lumbar interbody fusion (LLIF) in a single prone position may pose many advantages over the traditional lateral decubitus position, but there are questions concerning its safety profile and outcomes.

Purpose:

We sought to study the safety and efficacy of LLIF performed with the patient in the prone position.

Methods:

We conducted a retrospective cohort study including patients who underwent primary LLIF in the prone position for degenerative lumbar conditions. Complications and patient-reported outcome measures (PROMs) (Oswestry Disability Index [ODI], and visual analogue scale [VAS] scores for leg and back pain) were collected. Patients who underwent single-position prone LLIF were then propensity score matched for age, race, comorbidity index, number of levels, body mass index, and smoking status with patients who underwent single-position lateral LLIF. Patient-reported outcome measures and complications were compared between the 2 groups. Two postoperative timepoints were defined: early (<6 months) and late (≥6 months).

Results:

Twenty single-position prone LLIF patients were included (35% 1-level, 35% 2-level, 15% 3-level, and 15% 4-level). No intraoperative complications were reported. Eleven (55%) patients experienced transient postoperative anterior thigh weakness. Five (25%) patients experienced postoperative complications such as anemia, urinary retention, ileus, and new-onset sensory symptoms. Oswestry Disability Index, VAS leg, and VAS back scores all improved at the >6-month time point compared with preoperative states. There were no significant differences at any postoperative time point for PROMs between prone and lateral LLIF groups. Among the matched cohort, complications were observed in 3 (21%) of patients compared with only 1 (7%) in the lateral group although this difference was not statistically significant.

Conclusion:

This retrospective study suggests that prone LLIF procedures may be safe and effective. Ergonomic and logistic benefits from the approach may make it a beneficial approach for surgeons to begin implementing.

Keywords

lateral lumbar interbody fusion prone single position PROMs

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References

Adogwa

Elsamadicy

Han

Cheng

Karikari

Bagley

. Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes? J Neurosurg Spine. 2016;25(6):689–696. https://doi.org/10.3171/2015.8.SPINE15476.

Alluri

Avrumova

Sivaganesan

Vaishnav

Lebl

Qureshi

. Overview of robotic technology in spine surgery. HSS J. 2021;17(3):308–316. https://doi.org/10.1177/15563316211026647.

Berjano

Langella

Damilano

, et al. Fusion rate following extreme lateral lumbar interbody fusion. Eur Spine J. 2015;24(suppl 3):369–371. https://doi.org/10.1007/s00586-015-3929-7.

Blizzard

Thomas

. MIS single-position lateral and oblique lateral lumbar interbody fusion and bilateral pedicle screw fixation: feasibility and perioperative results. Spine (Phila Pa 1976). 2018;43(6):440–446. https://doi.org/10.1097/BRS.0000000000002330.

Copay

Glassman

Subach

Berven

Schuler

Carreon

. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, medical outcomes study questionnaire short form 36, and pain scales. Spine J. 2008;8(6):968–974. https://doi.org/10.1016/j.spinee.2007.11.006.

Farber

Naeem

Bhargava

Porter

. Single-position prone lateral transpsoas approach: early experience and outcomes [published online ahead of print October 22, 2021]. J Neurosurg Spine. https://doi.org/10.3171/2021.6.SPINE21420.

Goh

Soh

RCC

Yue

Guo

Tan

Chen

JLT

. The patient acceptable symptom state for the Oswestry Disability Index following single-level lumbar fusion for degenerative spondylolisthesis. Spine J. 2021;21(4):598–609. https://doi.org/10.1016/j.spinee.2020.11.008.

Harris

Taylor

Minor

, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. https://doi.org/10.1016/j.jbi.2019.103208.

Harris

Taylor

Thielke

Payne

Gonzalez

Conde

. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010.

10.

Joseph

Smith

La Marca

Park

. Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus. 2015;39(4):E4. https://doi.org/10.3171/2015.7.FOCUS15278.

11.

Knight

Schwaegler

Hanscom

Roh

. Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile. J Spinal Disord Tech. 2009;22(1):34–37. https://doi.org/10.1097/BSD.0b013e3181679b8a.

12.

Kwon

Kim

. Lateral lumbar interbody fusion: indications, outcomes, and complications. J Am Acad Orthop Surg. 2016;24(2):96–105. https://doi.org/10.5435/JAAOS-D-14-00208.

13.

Lamartina

Berjano

. Prone single-position extreme lateral interbody fusion (Pro-XLIF): preliminary results. Eur Spine J. 2020;29(suppl 1):6–13. https://doi.org/10.1007/s00586-020-06303-z.

14.

Martirosyan

Uribe

Randolph

Buchanan

. Prone lateral lumbar interbody fusion: case report and technical note. World Neurosurg. 2020;144:170–177. https://doi.org/10.1016/j.wneu.2020.08.172.

15.

North

Strong

Yee

Kashlan

Oppenlander

Park

. Navigation and robotic-assisted single-position prone lateral lumbar interbody fusion: technique, feasibility, safety, and case series. World Neurosurg. 2021;152:221–230e1. https://doi.org/10.1016/j.wneu.2021.05.097.

16.

Ohiorhenuan

Godzik

Uribe

. Single-position surgery: prone lateral lumbar interbody fusion: 2-dimensional operative video. Oper Neurosurg (Hagerstown). 2021;20(5):E369. https://doi.org/10.1093/ons/opaa478.

17.

Ouchida

Kanemura

Satake

Nakashima

Ishikawa

Imagama

. Simultaneous single-position lateral interbody fusion and percutaneous pedicle screw fixation using O-arm-based navigation reduces the occupancy time of the operating room. Eur Spine J. 2020;29(6):1277–1286. https://doi.org/10.1007/s00586-020-06388-6.

18.

Patel

Jacob

Pawlowski

, et al. Predictors of early clinically significant improvement among lumbar fusion patients: a multivariate analysis. J Orthopaedic Exper Innov. 2022. Available at: https://journaloei.scholasticahq.com/article/34668-predictors-of-early-clinically-significant-improvement-among-lumbar-fusion-patients-a-multivariate-analysis. Accessed December 31, 2022.

19.

Pimenta

Taylor

Stone

Wali

Santiago-Dieppa

. Prone transpsoas technique for simultaneous single-position access to the anterior and posterior lumbar spine. Oper Neurosurg (Hagerstown). 2020;20(1):E5–E12. https://doi.org/10.1093/ons/opaa328.

20.

Reisener

Pumberger

Shue

Girardi

Hughes

. Trends in lumbar spinal fusion—a literature review. J Spine Surg. 2020;6(4):752–761. https://doi.org/10.21037/jss-20-492.

21.

Salzmann

Shue

Hughes

. Lateral lumbar interbody fusion—outcomes and complications. Curr Rev Musculoskelet Med. 2017;10(4):539–546. https://doi.org/10.1007/s12178-017-9444-1.

22.

Shahi

Shinn

Singh

, et al. ODI <25 denotes patient acceptable symptom state after minimally invasive lumbar spine surgery. Spine (Phila Pa 1976). 2022;48:196–202. https://doi.org/10.1097/brs.0000000000004479.

23.

Sharma

Kepler

Girardi

Cammisa

Huang

Sama

. Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. J Spinal Disord Tech. 2011;24(4):242–250. https://doi.org/10.1097/BSD.0b013e3181ecf995.

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