Objective:

Many surgical options exist for multi-level lumbar interbody fusion, including anterior (ALIF) and lateral (LLIF) lumbar interbody fusions. While current technique of repositioning patients between supine ALIF and lateral decubitus LLIF offers many benefits, intra-operative repositioning can be cumbersome. We present a novel approach that accomplishes both multi-level LLIF and L5-S1 ALIF in a lateral decubitus position.

Methods:

This case series retrospectively enrolled 12 consecutive patients who underwent L5-S1 ALIF in the lateral decubitus position and anterior-to-psoas LLIF at more cranial levels as part of a multi-level lumbar interbody fusion surgery between September 2020 and December 2021. All surgeries were performed by a single spine-focused neurosurgeon at an urban academic hospital.

Results:

Radiographic imaging analysis demonstrated significant changes in coronal Cobb angle (-5.43° ± 3.81°; p = .0029), global lumbar lordosis (6.77° ± 12.04°; p = .0049), segmental lumbar lordosis (8.91° ± 10.21°; p = .0005), spinopelvic mismatch (-7.93° ± 7.91°; p = .0010), average disc height (5.30 ± 1.64 mm; p = .0005), and L5-S1 disc height (6.68 ± 2.10 mm; p = .0005). 2 patients developed post-operative complications including wound dehiscence and grade I graft subsidence at L4-L5.results CONCLUSIONS: This case series demonstrated that a combined lateral decubitus L5-S1 ALIF and LLIF at more cranial levels is a safe, efficient approach to multi-level lumbar interbody fusions. This technique significantly restored spinopelvic alignments with a low complication rate and no patient repositioning. Efficacy of this minimally invasive deformity correction technique should be further investigated through a multi-center trial.