Single-Position Prone Lateral Interbody Fusion is Associated with Improved Radiographic and Clinical Outcomes at One Year compared to Single-Position Lateral Interbody Fusion: A Single Institution Experience.

Background: Recent studies highlight the increasing adoption of single-position prone lateral(SP-PL) and single-position lateral decubitus(SP-LD) in Minimally Invasive Spine Surgery(MISS) to reduce operative time, enhance patient safety, and improve surgical accessibility.
Objective: To assess the differences between SP-PL and SP-LD achievement of optimal postoperative outcomes and post-operative complication rates.
Study Design: Retrospective review of prospectively collected MIS database.
Methods: Consecutive series of 152 Patients with baseline(BL) and 1-year(1Y) postoperative radiographic/HRQL data were included. Patients placed in the SP-PL or SP-LD were isolated. Optimal Outcome(OO) was defined as patients who experienced no complication requiring reoperation and achieved Substantial Clinical Benefit(SCB) for NRS-leg or NRS-back. Means comparison analysis assessed differences in radiographic and clinical outcomes. ANCOVA and multivariable backward stepwise logistic regression were used to adjust for confounders.
Results: 59 SP-PL and 93 SP-LD patients were included. At baseline, cohorts were comparable in terms of age, gender, BMI, and CCI. Peri-operatively, SP-PL patients had a significantly lower operative time(207.22 vs. 317.5 min;P<0.001), LOS(3.1 vs. 3.6 days;P=0.033), EBL(244.5 vs. 376.3 mL;P=0.023), and demonstrated lower perioperative complication rate(25.4% vs. 41.9%;P=0.038). Multivariable analysis indicated that SP-PL patients had a lower likelihood of cardiac perioperative complications(OR 0.012;CI95%: 0.0-0.6;P=0.026). Immediate postoperatively, SP-PL has a greater degree of segmental lordosis improvement from L1-L2 to L5-S1(all;P<0.05). SP-PL patients have a higher likelihood of achieving SCB NRS-Back at 1Y(OR: 8.0;CI95%: 1.5-42.0;P=0.014) and MCID NRS-leg at 1Y(OR:4.6;CI95%:1.002-21.2;P=0.49). The SP-PL cohort had a significantly greater percentage of OO(96.6% vs. 78.5%;P=0.002) and a higher likelihood of achieving OO in adjusted analysis (OR:10.6;CI95%: 2.1-53.3;P=0.004).
Conclusions: Patients placed in the SP-PL during minimally invasive spine surgery exhibit a reduced rate of perioperative complications, higher incidence of SCB, and a superior rate of achieving optimal outcome at the one-year follow-up. These findings underscore the SP-PL position as a potentially advantageous approach for minimally invasive lumbar fusion.
Competing Interests: Conflicts of Interest related to current work: Peter Gust Passias, MD. Allosource: Other financial or material support. Cervical Scoliosis Research Society: Research support. Globus Medical: Paid presenter or speaker. Medtronic: Paid consultant. Royal Biologics: Paid consultant. Spine: Editorial or governing board. SpineWave: Paid consultant. Terumo: Paid consultant. Zimmer: Paid presenter or speaker. Andrew J Schoenfeld, MD. AAOS: Board or committee member. Journal of Bone and Joint Surgery - American: Editorial or governing board. North American Spine Society: Board or committee member. Spine: Editorial or governing board. Springer: Publishing royalties, financial or material support. Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support. Christopher I Shaffrey, MD. AANS: Board or committee member. Cervical Spine Research Society: Board or committee member. DePuy, A Johnson & Johnson Company: Paid presenter or speaker; Research support. Globus Medical: Research support. Medtronic: Other financial or material support; Paid consultant. Medtronic Sofamor Danek: IP royalties; Paid presenter or speaker; Research support. Neurosurgery RRC: Board or committee member. Nuvasive: IP royalties; Paid consultant; Paid presenter or speaker; Research support; Stock or stock Options Proprio: Paid consultant. Scoliosis Research Society: Board or committee member. SI Bone: IP royalties. Spinal Deformity: Editorial or governing board. Spine: Editorial or governing board. Muhammad M. Abd-El-Barr, MD, PhD. Consultant for Spineology, Depuy Synthes, TrackX, and Spinal Elements.. Receives research support from the NIH, Abbvie, and the Dana and Christopher Reeve Foundation.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)