Single position versus lateral-then-prone positioning for lateral interbody fusion and pedicle screw fixation

Chason Ziino, Jaclyn A. Konopka, Remi M. Ajiboye, Justin B. Ledesma, Jayme C. B. Koltsov, Ivan Cheng


Background: To compare perioperative and radiographic outcomes following lateral lumbar interbody fusions in two cohorts of patients who either underwent single position or dual position surgery.
Methods: Patients over the age of 18 with degenerative lumbar pathology who underwent a lumbar interbody fusion via lateral access from 2012–2015 from a single surgeon met inclusion criteria. Patients who underwent combined procedures, had a history of retroperitoneal surgery, or had inadequate preoperative imaging were excluded. Patients who remained in the lateral decubitus position for pedicle screw fixation [single-position (SP)] were compared to those turned prone [dual-position (DP)]. Demographics, surgical details, and perioperative outcomes were compared between groups.
Results: A total of 42 SP and 24 DP patients were analyzed. The DP group had a 44.4-minute longer operating room time compared to the SP group (P<0.001) after adjusting for the number of levels operated (P<0.001) and unilateral versus bilateral screw placement (P=0.048). Otherwise, no differences were observed in peri-operative outcomes. Lordosis was not different between groups pre-operatively (P>0.999) or post-operatively (P=0.479), and neither was the pre- to post-operative change (P=0.283).
Conclusions: Lateral pedicle screw fixation following lateral interbody fusion decreases operating room time without compromising post-operative lordosis, complication rates, or perioperative outcomes.