Article Abstract

Analysis of single-position for revision surgery using lateral interbody fusion and pedicle screw fixation: feasibility and perioperative results

Authors: Chason Ziino, Alexander Arzeno, Ivan Cheng

Abstract

Background: To analyze perioperative and radiographic outcomes following revision surgery using lateral lumbar interbody fusion (LLIF) performed entirely in the lateral position. Traditionally, patients undergoing interbody fusion in the lateral decubitus position are placed prone for pedicle screw fixation. However prone positioning carries known risks and may increase surgical time due to the need to re-drape and reposition. Little is published regarding revision surgery in a single position.
Methods: Sixteen patients over the age of 18 with degenerative lumbar pathology who underwent a revision of previous lumbar fusion using interbody fusion via lateral access and revision of posterior instrumentation from a single surgeon met inclusion criteria. Patients who underwent combined procedures requiring repositioning or had inadequate preoperative imaging were excluded. Patients remained in the lateral decubitus position for the entirety of the procedure including interbody placement, revision of prior instrumentation, and pedicle screw fixation. Demographics, surgical details, and perioperative outcomes were reported.
Results: The mean operative time was 211 minutes for all cases, 161 minutes for single-level procedures and 296 minutes for two-level procedures. Mean estimated blood loss was 206 cc. The mean patient age was 66, 70% of which were male. The mean body mass index (BMI) was 27.4 and Charleson Comorbidity Index (CCI) was 3. All cases were performed on the lumbar spine (T12/L1–L4/L5), with the majority of procedures performed at the L2/3 level (44%). The mean pelvic incidence (PI) was 60 degrees (range, 41–71 degrees) with mean preoperative PI/lumbar lordosis (LL) mismatch of 23.9 degrees. Mean postoperative PI/LL mismatch was 12 degrees.
Conclusions: Revision surgery in the lateral position is feasible with complication rates comparable to published literature. The need to reposition is eliminated and single position surgery reduces operative time.