Advances in Lateral Interbody Fusion and Single Position Surgery

Abstract

Lateral lumbar interbody fusion (LLIF) is traditionally performed with the patient in the lateral decubitus position for interbody implant insertion and indirect decompression. In cases requiring 360-degree fusion or direct decompression, the patient is repositioned to the prone position during surgery, a technique referred to as dual-position LLIF (DP-L). To improve efficiency and eliminate the need for repositioning, surgeons have adopted single-position approaches, completing the entire procedure either in the lateral decubitus or prone position. This explores the advancements in LLIF and single-position LLIF. Comparing both single position lateral decubitus LLIF and single position prone (P-SPS) to the traditional DP-L. A narrative review of the literature on single-position surgery (SPS) LLIF was conducted to provide an overview of its key aspects and clinical applications. The review included studies comparing SPS lateral and SPS prone to DP-L, encompassing systematic reviews, meta-analyses, retrospective studies, and case series. Additional studies deemed relevant for a thorough review were also included. No randomized controlled trials were identified or included in this review. Lateral single-position surgery and P-SPS have shown reductions in operative times and hospital length of stay compared with DP LLIF. In addition, both techniques improved estimated blood loss, complication rates, and radiographic outcomes. However, the statistical significance of these findings varied inconsistently across the published studies. The development of LLIF represents a notable advancement in spine surgery. SPS builds on this foundation, offering potential improvements over the original technique. While SPS has demonstrated certain advantages, there remains room for further refinement and optimization in its application.