Research ArticleLumbar Spine

Single-Position Anterior Column Lateral Lumbar Interbody Fusion

Gregory Lopez, Arash J. Sayari and Frank Phillips
International Journal of Spine Surgery April 2022, 16 (S1) S17-S25; DOI: https://doi.org/10.14444/8232

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Radiograph demonstrating a patient with a recessed L5-S1 segment. The patient’s pubic symphysis is blocking easy entry into the L5-S1 segment, making anterior exposure difficult and especially not recommended for the lateral position.

  • Figure 2
    Figure 2

    Images depicting a 55-year-old man with a Grade 1 isthmic spondylolisthesis with severe foraminal stenosis (A), (B). The common iliac vessels are on either side of the midline of L5-S1 disc space (A), allowing for adequate lateral anterior lumbar interbody fusion exposure. The postoperative fluoroscopic images (C) demonstrate adequate reduction of the spondylolisthesis.

  • Figure 3
    Figure 3

    Axial cut T2-magnetic resonance imaging demonstrates anteriorly-migrated psoas, similarly migrating the lumbar plexus and increasing the risk for injury with a direct lateral approach in this patient.

  • Figure 4
    Figure 4

    A patient in the lateral decubitus position for single-position lateral surgery is depicted prior to draping. The patient is taped to the bed with the posterior holders in place on the inferior portion of the sacrum and thoracic spine.

  • Figure 5
    Figure 5

    Illustration of the lateral anterior lumbar interbody fusion retroperitoneal exposure.

  • Figure 6
    Figure 6

    Intraoperative fluoroscopic image of the L5-S1 segment that allows for analysis of the vertebral body rotation, retractor placement, and assessment of the midline.

  • Figure 7
    Figure 7

    An intraoperative picture depicting simultaneous anterior and posterior manipulation of the spine.

Tables

  • Table 1

    Single-position lateral lumbar interbody fusion.

    Indications

    • Spondylolisthesis

    • Advanced degenerative disc disease

    • Central or neuroforaminal stenosis

    • Degenerative scoliosis/kyphosis

    • Adjacent segment disease

    • Pseudarthrosis

    Relative Contraindications

    • Morbid obesity

    • Previous retroperitoneal surgery or radiation

    • High-grade spondylolisthesis

    • Impaired bone mineral density

    • Severe facet arthrosis

  • Table 2

    Single-position lateral lumbar interbody fusion: outcomes and complications.

    StudyKey Findings
    Hiyama et al, 201940

    • Operative time 31 min longer in dual-positioned group (129.7 vs 98.4 min)

    • No significant difference in lumbar lordosis, segmental lordosis, or disc height between single-position and flip procedures

    • Central canal diameter increased in both single-position and flip procedure groups, with no significant difference

    Buckland et al, 202110 Single-position cohort characterized by significantly reduced operative time (103 vs 306 min), EBL (97 vs 313 mL), fluoroscopy usage (32 vs 88 mGy), and postoperative length of stay (1.7 vs 4.1 d)
    Ziino et al, 201841 Dual-position operative time was significantly longer (226 vs 128 min), with no difference in immediate postoperative outcomes or lumbar lordosis
    Ashayeri et al, 202242

    • Single-position group had a significant reduction in OR time (132 vs 261 min), EBL (120 vs 224 mL), and rate of ileus postoperatively (0% vs 6%)

    • No differences in fluoroscopy use or perioperative complications, including vascular injury, retrograde ejaculation, abdominal injury, neuropraxia, wound complications, or VTE, were noted

    • EBL, estimated blood loss; VTE, venous thromboembolism.

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Single-Position Anterior Column Lateral Lumbar Interbody Fusion
Gregory Lopez, Arash J. Sayari, Frank Phillips
International Journal of Spine Surgery Apr 2022, 16 (S1) S17-S25; DOI: 10.14444/8232
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