Prone single-position extreme lateral interbody fusion (Pro-XLIF): preliminary results

Lamartina, Claudio; Berjano, Pedro

doi:10.1007/s00586-020-06303-z

Cited by 72 publications

(71 citation statements)

References 19 publications

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“…However, comparatively, we did not experience any episodes of intraoperative cage subsidence. While we did not evaluate surgical outcomes in the current study, we did note a rate of postoperative hip pain that was similar to that published by Lamartina and Berjano, 20 which appeared similarly transient. Overall, we agree that such prone positioning presents an attractive option for streamlined surgical solutions.…”

Section: Discussionsupporting

confidence: 76%

Single-position prone lateral approach: cadaveric feasibility study and early clinical experience

Godzik

Ohiorhenuan

et al. 2020

Neurosurgical Focus

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OBJECTIVELateral lumbar interbody fusion (LLIF) is a useful minimally invasive technique for achieving anterior interbody fusion and preserving or restoring lumbar lordosis. However, achieving circumferential fusion via posterior instrumentation after an LLIF can be challenging, requiring either repositioning the patient or placing pedicle screws in the lateral position. Here, the authors explore an alternative single-position approach: LLIF in the prone lateral (PL) position.METHODSA cadaveric feasibility study was performed using 2 human cadaveric specimens. A retrospective 2-center early clinical series was performed for patients who had undergone a minimally invasive lateral procedure in the prone position between August 2019 and March 2020. Case duration, retractor time, electrophysiological thresholds, implant size, screw accuracy, and complications were recorded. Early postoperative radiographic outcomes were reported.RESULTSA PL LLIF was successfully performed in 2 cadavers without causing injury to a vessel or the bowel. No intraoperative subsidence was observed. In the clinical series, 12 patients underwent attempted PL surgery, although 1 case was converted to standard lateral positioning. Thus, 11 patients successfully underwent PL LLIF (89%) across 14 levels: L2–3 (2 of 14 [14%]), L3–4 (6 of 14 [43%]), and L4–5 (6 of 14 [43%]). For the 11 PL patients, the mean (± SD) age was 61 ± 16 years, mean BMI was 25.8 ± 4.8, and mean retractor time per level was 15 ± 6 minutes with the longest retractor time at L2–3 and the shortest at L4–5. No intraoperative subsidence was noted on routine postoperative imaging.CONCLUSIONSPerforming single-position lateral transpsoas interbody fusion with the patient prone is anatomically feasible, and in an early clinical experience, it appeared safe and reproducible. Prone positioning for a lateral approach presents an exciting opportunity for streamlining surgical access to the lumbar spine and facilitating more efficient surgical solutions with potential clinical and economic advantages.

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Section: Discussionsupporting

confidence: 76%

Single-position prone lateral approach: cadaveric feasibility study and early clinical experience

Godzik

Ohiorhenuan

et al. 2020

Neurosurgical Focus

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“…Whether prone LLIF results in possibly less neurologic complications due to the relatively increased safe working at L4-L5, or more neurologic complications due to increased tension on the lumbar plexus has yet to be determined in clinical studies. 17,29 Previous retrospective studies assessing prone LLIF have reported a neurologic complication rate ranging from 37% to 57%, [16][17][18] which ranges within the neurologic complication rate associated with traditional lateral decubitus LLIF. [30][31][32][33][34] One prospective, non-randomized, comparative study assessed seven patients undergoing prone LLIF and ten patients undergoing traditional lateral decubitus LLIF.…”

Section: Discussionmentioning

confidence: 99%

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Alluri

Clark

Sheha

et al. 2021

Global Spine Journal

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Study Design Cadaveric study. Objective To compare the position of the femoral nerve within the lumbar plexus at the L4-L5 disc space in the lateral decubitus vs prone position. Methods Seven lumbar plexus specimens were dissected and the femoral nerve within the psoas muscle was identified and marked with radiopaque paint. Lateral fluoroscopic images of the cadaveric specimens in the lateral decubitus vs prone position were obtained. The location of the radiopaque femoral nerve at the L4-L5 disc space was normalized as a percentage of the L5 vertebral body (0% indicates posterior location and 100% indicates anterior location at the L4-L5 disc space). The location of the femoral nerve at L4-L5 in the lateral decubitus vs prone position was compared using a paired t test. Results In the lateral decubitus position, the femoral nerve was located 28% anteriorly from the posterior edge of the L4-L5 disc space, and in the prone position, the femoral nerve was relatively more posterior, located 18% from the posterior edge of the L4-L5 disc space ( P = .037). Conclusions The femoral nerve was on average more posteriorly located at the L4-L5 disc space in the prone position compared to lateral decubitus. This more posterior location allows for a larger safe zone at the L4-L5 disc space, which may decrease the incidence of neurologic complications associated with Lateral lumbar interbody fusion in the prone vs lateral decubitus position; however, further studies are needed to evaluate this possible clinical correlation.

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“…6 Lamartina introduced the feasibility of conducting the extreme lateral interbody fusion with posterior fixation in the prone position. 14 This study outlined a reduced mean surgical time of 133.8 ± 26.6 minutes in the prone position, as compared to 182.8 ± 47.9 minutes in standard lateral decubitus. Walker et al 15 report a similar lengthened mean surgical time of 203.6 ± 64.8 minutes in standard lateral decubitus, as well as similar rates of known complications.…”

Section: Discussionmentioning

confidence: 84%

“…Walker et al 15 report a similar lengthened mean surgical time of 203.6 ± 64.8 minutes in standard lateral decubitus, as well as similar rates of known complications. 14…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Robotic Single Position Oblique Lumbar Interbody Fusion With Bilateral Sacropelvic Fixation in Lateral Decubitus

et al. 2021

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Single position lateral fusion reduces the need for a secondary surgery and robotic guidance allows for potentially higher accuracy of screw placement. We expand the role of robotics with a simultaneous workflow where 2 surgeons can work in single position surgery and discuss the technical feasibility of placement of S2-alar-iliac (S2AI) screws in the lateral position. A 70-year-old male presented with chronic back pain and bilateral leg pain with the left side worse than the right. He subsequently underwent an L3-S1 oblique lumbar interbody fusion (OLIF) with a minimally invasive L3-ilium robotic posterior spinal fixation simultaneously in single lateral position with S2AI screws. The software planning requisite of robotics allowed for a preoperative plan where lumbar cortical screws were used to line up with bilateral S2AI screws. Intraoperatively, the OLIF was performed anterior to the patient which allowed for a second surgeon to perform the posterior stage of screw placement simultaneously in overlapping fashion during OLIF exposure. Once all screws were placed, the OLIF discectomy and cage placement were completed. As the OLIF incision is closed, rodding proceeds posteriorly with subsequent closure simultaneously as well. Operative time from skin incision to skin closure was 3 hours and 47 minutes. We present here a novel technical report on the recommended workflow of simultaneous robotic single position surgery OLIF and demonstrate the feasibility of placement of sacroiliac fixation in the lateral decubitus position. We believe this technique to be minimally invasive, effective, with the benefit of shortening valuable operating room case time.

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Prone single-position extreme lateral interbody fusion (Pro-XLIF): preliminary results

Cited by 72 publications

References 19 publications

Single-position prone lateral approach: cadaveric feasibility study and early clinical experience

Single-position prone lateral approach: cadaveric feasibility study and early clinical experience

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Simultaneous Robotic Single Position Oblique Lumbar Interbody Fusion With Bilateral Sacropelvic Fixation in Lateral Decubitus

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