1Patel A, 2McDermott M, 3Rogers M, 4Prior R, 1Byrne N, 1Doshi E
1Duly Health and Care, Downers Grove, Illinois, United states; 2Ohio University, Athens, Ohio, United states; 3Ross University, Miramar, Florida, United states; 4Fransiscan Health Olympia Fields, Olympia Fields, Illinois, United states
Introduction
Lateral lumbar interbody fusion (LLIF) allows for indirect decompression of central and foraminal stenosis, restoration of lordosis, and anterior fusion during surgical treatment of lumbar degenerative pathologies. Performing a LLIF in the prone position (p-LLIF) has recently gained popularity due to the substantial improvement in time under anesthesia and cost efficiency of avoiding the flip from the traditional lateral decubitus to the prone position for decompression/osteotomy or placement of screws. We performed a retrospective look at our data and report complications.
Material and Methods
A retrospective chart review was conducted including intraoperative and perioperative data from patients who underwent p-LLIF from May 2019 to September 2022.
Results
Our experience included a total of 233 interbody levels in 145 patients with an average age of 66.7 years. There were 86 single-level (59%), 34 two-level (23%), 21 three-level (14%), and 4 four-level (2%) surgeries performed. The average BMI for single-level surgery was 30.3 kg/m2 (min-max 17.2-50.3). Ninety-four patients (40%) underwent a prone lateral lumbar interbody fusion (p-LLIF) inclusive of the L4-5 level. Four corpectomies and four anterior column reconstructions were performed. One hundred and forty-one (141) patients had concomitant posterior work completed. The average surgical time for a single-level surgery was 89mins (min-max 40-185), with an average length of hospital stay of 1.8days (min-max 0-7; SD=1.5), and an average estimated blood loss of 61 mL (min-max 20-300). There were 2 cases of an unintentional anterior longitudinal ligament (ALL) rupture requiring interbody with plate fixation and 3 cases of femoral nerve palsy, 2 of which recovered fully at 6weeks, and a single case that improved to 4/5 at one-year post-op. There was 1 case of revision for implant malposition impinging on the contralateral foramen. There were no cases of vascular, bowel, or complete spinal cord/root/plexus injury.
Conclusion
Our single surgeon experience data demonstrates the utilization of the p-LLIF technique in treating single and multilevel degenerative disease of the lumbar spine. In addition, our data demonstrates a length of hospital stay and complication profile like that of a traditional LLIF performed in the lateral decubitus position. Further long-term studies are required to understand the complete utility of this approach and the benefits of widespread adoption. Nevertheless, early data demonstrates a substantial improvement in surgical time by avoiding the need for prone repositioning.
