Single position lateral lumbar interbody fusion and pedicle screw fixation: preliminary experience and perioperative results

Abstract

Aim: The purpose of this study was to review a single surgeon’s preliminary experiences with minimally invasive single lateral position anterior-to-psoas lumbar interbody fusion with multiple techniques of percutaneous pedicle screws and present perioperative results and complication rates.

Methods: After obtaining Institutional Review Board approval, thirty-five consecutive patients undergoing, in 2018-2020, single position lateral interbody fusion with posterior fixation after obtaining written informed consent. Pedicle screw accuracy, screw-related complications, overall and segmental lumbar lordosis, intraoperative data, perioperative complications, and Visual Analog Pain Scale (VAS) at 6 months follow-up were collected.

Results: One hundred sixty-nine pedicle screws were placed in 35 patients with a 95.3% accuracy rate. 6/7 breaches measured < 2 mm. No complications or reoperations were performed in relation to screw malposition. Mean preoperative overall lumbar lordosis was 45.6° ± 12.5° (range, 19°-71°), and 50.3° ± 9.6° (range, 25°-67°) at 6 months follow up. Mean preoperative VAS scores were 7.3 ± 1.2 (range, 5-10) and 7.3 ± 1.3 (range, 5-10) for the back and leg, respectively and at 6 months follow up, 2.6 ± 2.3 (range, 0-7) and 2.6 ± 2.2 (range, 0-7) for the back and leg, respectively. The mean total operative time was 152.2 ± 54.8 min (range, 80-320 min).

Conclusion: Single lateral position antepsoas lumbar interbody fusion with bilateral percutaneous pedicle screws and rod fixation report comparable screw accuracy rates, operative times, and lordosis correction with the published literature. This modified technique eliminates the resources and time related to intraoperative prone repositioning and may lead to significant cost savings.

Keywords

Lumbar interbody fusion / extreme lateral interbody fusion / pedicle screw / computer-assisted navigation / minimally invasive surgery

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