Introduction: Performing lateral lumbar interbody fusion (LLIF) in a single prone position may pose many advantages to the traditional lateral decubitus position. However, there are questions concerning its safety profile and outcomes. We hypothesize that prone lateral lumbar interbody fusion is safe and effective.
Methods: Patients who underwent primary LLIF in a prone position for degenerative lumbar conditions were included. Complications and patient-reported outcomes (PROs) (ODI, VAS leg/back) were analyzed for differences compared to preoperative. Patients were then propensity score matched for age, race, comorbidity index, number of levels, BMI, and smoking status with patients that underwent single-position lateral LLIF. PROs and complications were compared between the two groups. Two postoperative timepoints were defined: early ( < 6 months) and late (>6 months).
Results: 20 patients were included (35% 1-level, 35% 2-level, 15% 3-level, 15% 4-level). No intraoperative complication was reported. 11 (55%) experienced transient postoperative anterior thigh weakness. 6 (30%) experienced postoperative complications including anemia, urinary retention, ileus, and new onset sensory symptoms. ODI (p=0.01), VAS-Leg (p=0.08), Vas-Back (p < 0.01) all improved at the >6 month time point compared to preoperative states. In the matched cohort, there were no significant differences at any post-operative time point for any PROM between prone and lateral LLIF (p=0.46, p=0.73, p=0.54 for ODI, VAS-Leg, and VAS-Back respectively). There was also no difference in complication rates between the 2 groups (p=0.6).
Conclusion : Prone LLIF procedures can be done safely and effectively. Ergonomic and logistic benefits from the approach may make it a beneficial approach for surgeons to begin implementing. Future studies with larger cohorts are important for further appreciation of this result.
