Resident Physician University of Michigan Ann Arbor, Michigan, United States
Introduction: Combination anterior and oblique/lateral interbody fusions have become a more widely used surgical approach for spine fusion surgery and indirect decompression but require supine to lateral repositioning intraoperatively. To improve overall efficiency, attention has turned to maintain a single-position supine approach to both anterior and oblique/lateral interbody cage placement. This has been demonstrated previously in a cadaveric study by Farber et al (2022), revealing the feasibility of performing LLIF (lateral lumbar interbody fusion) and ALIF (anterior lumbar interbody fusion) in a single-stage supine position. In this case, we demonstrate successful single-position supine and single-incision ALIF and OLIF (oblique lateral interbody fusion) in a 60-year-old male with multilevel degenerative lumbar stenosis causing back pain and radiculopathy.
Methods: The patient was offered an L3-S1 ALIF. A standard transverse incision in the left lower quadrant was used to complete an ALIF with a 17 mm Globus PEEK cage at L5-S1 with assistance from general surgery. General surgery was then able to separate the left common iliac artery and vein allowing dissection and preparation of the L4-L5 interspace window. After retractor application, it was felt that a standard ALIF cage could not be placed secondary to the severe collapse of the disc space. The skin incision was therefore extended laterally, and the dissection was followed laterally into the retroperitoneal space, such as for a standard LLIF dissection, albeit with the patient positioned supine. Access to the disc space was found between the iliac vessel and the psoas muscle and a standard OLIF was completed with the placement of an Elsa Globus cage. General surgery then completed a transperitoneal approach to L3-4 with mobilization of the great vessels for successful completion of an ALIF with 15 mm Globus PEEK cage placement. The incision was closed in layers according to the standard technique.
Results: Aside from the development of postoperative ileus, the patient did remarkably well and was discharged to home on post-op day 6. CT lumbar spine revealed evidence of osseous fusion at all levels at 8 months postop.
Conclusion : Single-position supine single-incision ALIF and OLIF/LLIF combination surgery can be successfully achieved.
