• Shaan Sadhwani, Michael Brown, Jonathan Dalton, Isaac Nivar, Jamie Henzes, Michael Marcinko, and Tyson Maugle.
• Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, Pennsylvania, USA. Electronic address: sadhwanis@upmc.edu.
• World Neurosurg. 2024 Jul 1; 187: e460e464e460-e464.

ObjectiveThe transpsoas lateral lumbar interbody fusion (LLIF) procedure is a minimally invasive lumbar spine approach that provides indirect neural decompression, improved sagittal alignment, and a high fusion rate. Typically accompanied by posterior pedicle screw insertion, there has been interest in performing LLIF in a single position to decrease cost and time under anesthesia. However, there is a paucity of direct comparisons between single-position LLIF via prone versus lateral decubitus positioning. Therefore, this study aims to compare the outcomes of a single surgeon performing prone versus lateral single-position LLIF, inclusive of the L4-L5 level.MethodsA retrospective review was performed of a consecutive case series of patients who underwent either prone or lateral, single-position LLIF by a single surgeon. All cases involved the L4-L5 level. Demographic data, perioperative details, clinical outcomes, and preoperative and postoperative lumbar lordosis were recorded.ResultsSixty-three patients underwent lateral and 16 patients underwent prone single-position LLIF. Demographics and average interbody size were similar between groups. Operative time, change in lumbar lordosis, and length of hospital stay did not differ between the 2 positions. Both groups performed similarly in terms of preoperative and postoperative visual analog score pain score and complications. Patients who underwent lateral position LLIF ambulated farther on postoperative day 1 (250 feet vs. 200 feet, P = 0.015). Average time to follow up was 53 weeks.ConclusionsThis study demonstrates promising preliminary results indicating that single-position LLIF performs well, even at the L4-L5 level, in both the prone and lateral positions.Copyright © 2024 Elsevier Inc. All rights reserved.

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