Single position lateral decubitus Anterior Lumbar Interbody Fusion (ALIF) and posterior fusion reduces complications and improves perioperative outcomes compared with traditional anterior-posterior lumbar fusion.

Abstract

BACKGROUND CONTEXT\nLateral decubitus single position anterior-posterior (AP) fusion utilizing anterior lumbar interbody fusion and percutaneous posterior fixation is a novel, minimally invasive surgical technique. Single position lumbar surgery (SPLS) with anterior lumbar interbody fusion (ALIF) or lateral lumbar interbody fusion (LLIF) has been shown to be a safe, effective technique. This study directly compares perioperative outcomes of SPLS with lateral ALIF v traditional supine ALIF with repositioning (FLIP) for degenerative pathologies.\n\n\nPURPOSE\nTo determine if SPLS with lateral ALIF improves perioperative outcomes compared to FLIP with supine ALIF STUDY DESIGN/SETTING: : Multicenter retrospective cohort study PATIENT SAMPLE: Patients undergoing primary AP fusions with ALIF at 5 institutions from 2015 to 2020.\n\n\nOUTCOME MEASURES\nLevels fused, inclusion of L4-L5, L5-S1, radiation dosage, operative time, estimated blood loss (EBL), length of stay (LOS), perioperative complications. Radiographic analysis included lumbar lordosis (LL), pelvic incidence (PI), and PI-LL mismatch.\n\n\nMETHODS\nRetrospective analysis of primary ALIFs with bilateral percutaneous pedicle screw fixation between L4-S1 over 5 years at 5 institutions. Patients were grouped as FLIP or SPLS. Demographic, procedural, perioperative, and radiographic outcome measures were compared using independent samples t-tests and chi-squared analyses with significance set at p<0.05. Cohorts were propensity-matched for demographic or procedural differences.\n\n\nRESULTS\nA total of 321 patients were included; 124 SPS and 197 Flip patients. Propensity-matching yielded 248 patients: 124 SPLS and 124 FLIP. The SPLS cohort demonstrated significantly reduced operative time (132.95±77.45 v 261.79±91.65 min; p<0.001), EBL (120.44±217.08 v 224.29±243.99 mL; p<0.001), LOS (2.07±1.26 v 3.47±1.40 days; p<0.001), and rate of perioperative ileus (0.00% v 6.45%; p=0.005). Radiation dose (39.79±31.66 v 37.54±35.85 mGy; p=0.719) and perioperative complications including vascular injury (1.61% v 1.61%; p=1.000), retrograde ejaculation (0.00% v 0.81%, p=0.328), abdominal wall (0.81% v 2.42%; p=0.338), neuropraxia (1.61% v 0.81%; p=0.532), persistent motor deficit (0.00% v 1.61%; p=0.166), wound complications (1.61% v 1.61%; p=1.000), or VTE (0.81% v 0.81%; p=0.972) were similar. No difference was seen in 90-day return to OR. Similar results were noted in sub-analyses of single-level L4-L5 or L5-S1 fusions. On radiographic analysis, the SPLS cohort had greater changes in LL (4.23±11.14 v 0.43±8.07 deg; p=0.005) and PI-LL mismatch (-4.78±8.77 v -0.39±7.51 deg; p=0.002).\n\n\nCONCLUSIONS\nSingle position lateral ALIF with percutaneous posterior fixation improves operative time, EBL, LOS, rate of ileus, and maintains safety compared to supine ALIF with prone percutaneous pedicle screws between L4-S1.