Background:

Lumbar lateral interbody fusion (LLIF) is traditionally performed in two stages: placing the interbody cage in the lateral decubitus position, followed by percutaneous pedicle screw placement in the prone position. Performing interbody fusion and posterior fixation simultaneously could improve operative efficiency and clinical outcomes associated with longer operative times. Here we describe the operative steps and report clinical and radiographic outcomes associated with simultaneous anterior and posterior approach (SAPA) for LLIF.

Methods:

Patients who underwent SAPA LLIF performed by a single surgeon were retrospectively reviewed over one year. Demographic, clinical, and radiographic data were analyzed, an operative guideline was created, and a learning curve was constructed using surgery operative times.

Results:

Eleven patients underwent SAPA LLIF. Three patients experienced transient post-operative femoral nerve plexopathy with symptoms of ipsilateral hip flexion weakness and/or anterior thigh numbness; there were no other complications in our cohort. Radiographically, patients achieved significant increases in disc height (8.3 mm vs. 13.5 mm, p = 0.002) and foraminal height (20.2 mm vs. 25.3 mm, p = .0001). Patients had significant improvements in ODI (52 vs. 27.8, p = 0.002), PROMIS physical function (32.6 vs. 39, p = 0.048), and PROMIS pain interference (64.9 vs 59.6, p = 0.001) at 3 months. We observed a downward trend in operative time for one-level SAPA LLIF.

Conclusion:

SAPA LLIF is a safe approach for LLIF that results in favorable clinical outcomes. This technique can potentially improve operative efficiency further along the course of a surgeon’s learning curve.