Minimally Invasive Deformity Correction Technique: Initial Case Series of Anterior Lumbar Interbody Fusion at L5-S1 for Multilevel Lumbar Interbody Fusion in a Lateral Decubitus Position

OBJECTIVE: Many surgical options exist for multilevel lumbar interbody fusion, including anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF). While current technique of repositioning patients between supine ALIF and lateral decubitus LLIF offers many benefits, intraoperative repositioning can be cumbersome. We present a novel approach that accomplishes both multilevel LLIF and L5-S1 ALIF in a lateral decubitus position. METHODS: This case series retrospectively enrolled 12 consecutive patients who underwent L5-S1 ALIF in the lateral decubitus position and anterior-to-psoas LLIF at more cranial levels as part of a multilevel lumbar interbody fusion surgery between September 2020 and December 2021. All surgeries were performed by a single spine-focused neurosurgeon at an urban academic hospital. RESULTS: Radiographic imaging analysis demonstrated significant changes in coronal Cobb angle (-5.43 degrees +/- 3.81 degrees; P = 0.0029), global lumbar lordosis (6.77 degrees +/- 12.04 degrees; P = 0.0049), segmental lumbar lordosis (8.91 degrees +/- 10.21 degrees; P = 0.0005), spinopelvic mismatch (-7.93 degrees +/- 7.91 degrees; P = 0.0010), average disc height (5.30 +/- 1.64 mm; P = 0.0005), and L5-S1 disc height (6.68 +/- 2.10 mm; P = 0.0005). Two patients developed postoperative complications including wound dehiscence and grade I graft subsidence at L4-L5. CONCLUSIONS: This case series demonstrated that a combined lateral decubitus L5-S1 ALIF and LLIF at more cranial levels is a safe, efficient approach to multilevel lumbar interbody fusions. This technique significantly restored spinopelvic alignments with a low complication rate and no patient repositioning. Efficacy of this minimally invasive deformity correction technique should be further investigated through a multicenter trial.

Automated summary

This study demonstrated that performing L5-S1 ALIF and anterior-to-psoas LLIF at more cranial levels in lateral decubitus position is an effective approach for restoring spinopelvic alignments with low complication rate and without patient repositioning.