Single-position circumferential lumbar spinal fusion: an overview of terminology, concepts, rationale and the current evidence base

Thomas, J. Alex; Menezes, Cristiano Magalhães; Buckland, Aaron J.; Khajavi, Kaveh; Ashayeri, Kimberly; Braly, Brett A.; Cheng, Ivan; Berjano, Pedro

doi:10.1007/s00586-022-07229-4

Cited by 8 publications

(9 citation statements)

References 46 publications

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“…Like its lateral SPS cousin, when compared with traditional dual-position anteriorposterior fusions, prone SPS greatly enhances operating room efficiency by avoiding wasted time spent on repositioning between stages and by allowing simultaneous work on both the anterior and posterior aspects of the spine. 20,21 Because of the above purported benefits, prone lateral surgery is increasing in popularity to treat certain lumbar conditions. Given the accelerating utilization of the technique, these results are particularly salient, while there is a paucity of quality clinical safety and outcome data available.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to addressing some of the limitations of LLIF, prone lateral surgery provides theoretical value as a form of single-position surgery (SPS). Like its lateral SPS cousin, when compared with traditional dual-position anterior-posterior fusions, prone SPS greatly enhances operating room efficiency by avoiding wasted time spent on repositioning between stages and by allowing simultaneous work on both the anterior and posterior aspects of the spine 20,21 …”

Section: Discussionmentioning

confidence: 99%

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Intra-abdominal Content Movement in Prone Versus Lateral Decubitus Position Lateral Lumbar Interbody Fusion (LLIF)

Menezes,

Andrade,

Lacerda

et al. 2024

Spine

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Study Design. A prospective, anatomical imaging study of healthy volunteer subjects in accurate surgical positions. Objective. To establish if there is a change in the position of the abdominal contents in the lateral decubitus versus prone position. Summary of Background Data. Lateral transpsoas lumbar interbody fusion (LLIF) in the lateral decubitus (LD) position has been validated anatomically and for procedural safety, specifically in relation to visceral risks. Recently, LLIF with the patient in the prone position has been suggested as an alternative to LLIF in the LD position. Methods. Subjects underwent magnetic resonance imaging (MRI) of the lumbosacral region in the right LD position with the hips flexed, and prone position with the legs extended. Anatomical measurements were performed on axial MRI images at the L4-5 disc space. Results. Thirty-four subjects were included. Distance from the skin to the lateral disc surface was 134.9 mm in prone compared with 118.7 mm in LD (P<0.0001). Distance between the posterior aspect of the disc and the colon was 20.3 mm in prone compared with 41.1 mm in LD (P<0.0001). The colon migrated more posteriorly in relation to the anterior margin of the psoas in prone compared with LD (21.7 mm vs. 5.5 mm, respectively (P<0.0001)). 100% of subjects had posterior migration of the colon in prone compared with LD position, as measured by the distance from the quadratum lumborum to the colon (44.4 mm vs. 20.5 mm, respectively (P<0.001)). Conclusion. There were profound changes in the position of visceral structures between the prone and LD patient positions in relation to the LLIF approach corridor. Compared with LD LLIF, the prone position results in a longer surgical corridor with a substantially smaller working window free of the colon, evidenced by the significant and uniform posterior migration of the colon. Surgeons should be aware of the potential for increased visceral risks when performing LLIF in the prone position. Level of Evidence. 2 – prospective anatomical cohort study

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intra-abdominal Content Movement in Prone Versus Lateral Decubitus Position Lateral Lumbar Interbody Fusion (LLIF)

Menezes,

Andrade,

Lacerda

et al. 2024

Spine

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“…The benefits of single-position lumbar fusion have been validated in several meta-analyses and single-center studies. 2 Buckland et al 3 showed that single-position surgery (ALIF and LLIF in the lateral position) improved surgical efficiency and reduced blood loss, length of stay, and ileus while maintaining safety compared with surgeries involving an intraoperative repositioning or flip. Ashayeri et al 4 propensity matched 124 single-position lateral ALIF surgeries with anterior-to-prone controls, finding that the single-position group had a lower surgical time, blood loss, length of stay, and rate of ileus compared with those who underwent repositioning.…”

Section: Advantages Of Single-position Surgerymentioning

confidence: 99%

“…Second, intraoperative patient repositioning has been associated with reduced surgical efficiency and increased blood loss, length of stay, and rates of ileus. 2-4 Finally, the change in venous compression can lead to bleeding or edema in the previous surgical site (eg, flipping a patient prone after an anterior approach to the spine).…”

mentioning

confidence: 99%

“…Second, intraoperative patient repositioning has been associated with reduced surgical efficiency and increased blood loss, length of stay, and rates of ileus. [2][3][4] Finally, the change in venous compression can lead to bleeding or edema in the previous surgical site (eg, flipping a patient prone after an anterior approach to the spine). Provided that the same surgical goals can be met, single-position MIS ASD surgery has the potential to decrease surgical time and reduce patient risk by avoiding repositioning.…”

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confidence: 99%

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Single-position Minimally Invasive Surgery for Correction of Adult Spinal Deformity

Lovecchio

Shahi

Patel

et al. 2023

J Am Acad Orthop Surg

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Minimally invasive adult spinal deformity (MIS ASD) surgery may offer benefits over conventional techniques in select circumstances. The success of the procedure is based on proper patient selection, restoring adequate alignment, and optimizing fusion. In the past, MIS techniques were limited because of the need to reposition the patient—a source of increased surgical time and potentially patient risk. New developments now allow for single-position, MIS correction of adult deformity. Additional research will be needed to determine the ideal patient for minimally invasive adult spinal deformity surgery and whether prone or lateral single-position confers the best outcomes.

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Simultaneous Single-Position Lateral Lumbar Interbody Fusion Surgery and Unilateral Percutaneous Pedicle Screw Fixation for Spondylolisthesis

Lv,

Yang,

Zhou

et al. 2023

Neurospine

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Objective: To evaluate the clinical and radiological efficacy of a combine of lateral single screw-rod and unilateral percutaneous pedicle screw fixation (LSUP) for lateral lumbar interbody fusion (LLIF) in the treatment of spondylolisthesis.Methods: Sixty-two consecutive patients with lumbar spondylolisthesis who underwent minimally invasive (MIS)-TLIF with bilateral pedicle screw (BPS) or LLIF-LSUP were retrospectively studied. Segmental lordosis angle (SLA), lumbar lordosis angle (LLA), disc height (DH), slipping percentage, the cross-sectional areas (CSA) of the thecal sac, screw placement accuracy, fusion rate and foraminal height (FH) were used to evaluate radiographic changes postoperatively. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy.Results: Patients who underwent LLIF-LSUP showed shorter operating time, less length of hospital stay and lower blood loss than MIS-TLIF. No statistical difference was found between the 2 groups in screw placement accuracy, overall complications, VAS, and ODI. Compared with MIS-TLIF-BPS, LLIF-LSUP had a significant improvement in sagittal parameters including DH, FH, LLA, and SLA. The CSA of MIS-TLIF-BPS was significantly increased than that of LLIF-LSUP. The fusion rate of LLIF-LSUP was significantly higher than that of MIS-TLIF-BPS at the follow-up of 3 months postoperatively, but there was no statistical difference between the 2 groups at the follow-up of 6 months, 9 months, and 12 months.Conclusion: The overall clinical outcomes and complications of LLIF-LSUP were comparable to that of MIS-TLIF-BPS in this series. Compared with MIS-TLIF-BPS, LLIF-LSUP for lumbar spondylolisthesis represents a significantly shorter operating time, hospital stay and lower blood loss, and demonstrates better radiological outcomes to maintain lumbar lordosis, and reveal an overwhelming superiority in the early fusion rate.

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Single-position circumferential lumbar spinal fusion: an overview of terminology, concepts, rationale and the current evidence base

Cited by 8 publications

References 46 publications

Intra-abdominal Content Movement in Prone Versus Lateral Decubitus Position Lateral Lumbar Interbody Fusion (LLIF)

Intra-abdominal Content Movement in Prone Versus Lateral Decubitus Position Lateral Lumbar Interbody Fusion (LLIF)

Single-position Minimally Invasive Surgery for Correction of Adult Spinal Deformity

Simultaneous Single-Position Lateral Lumbar Interbody Fusion Surgery and Unilateral Percutaneous Pedicle Screw Fixation for Spondylolisthesis

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