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Page 2 of 14 Choi et al. Mini-invasive Surg 2021;5:43 https://dx.doi.org/10.20517/2574-1225.2021.73

Conclusion: Single lateral position antepsoas lumbar interbody fusion with bilateral percutaneous pedicle screws
and rod fixation report comparable screw accuracy rates, operative times, and lordosis correction with the
published literature. This modified technique eliminates the resources and time related to intraoperative prone
repositioning and may lead to significant cost savings.

Keywords: Lumbar interbody fusion, extreme lateral interbody fusion, pedicle screw, computer-assisted navigation,
minimally invasive surgery

INTRODUCTION
Non-specific back pain due to degenerative lumbar disorders significantly reduces patient function,
[1,2]
increases pain scores, and impair quality of life . Lumbar interbody fusion (LIF) surgery has been widely
used as a viable option in treating lower back pain and associated neurological disorders refractory to
[3,4]
conservative treatment . Several options for open and minimally invasive surgical LIF include posterior or
transforaminal lumbar interbody fusion (P/TLIF) or anterior lumbar interbody fusion (ALIF) .
[5,6]
Recently, a more minimally invasive, lateral lumbar interbody fusion (LLIF) is attracting attention with two
main approaches; the transpsoas, direct LIF, and anterior-to-psoas, oblique LIF . Although these LLIF
[7,8]
approaches have not yet gained universal acceptance, early results show similar advantages to ALIF due to
its large intervertebral spacer providing restoration of alignment and effective indirect neural
decompression. The LLIF approaches also significantly mitigate the many approach-related visceral,
vascular, and reproductive complications seen in ALIF [9-15] .

LLIF traditionally requires intraoperative patient repositioning from the lateral decubitus to the prone
position to complete supplementary posterior instrumentation with bilateral pedicle screws .
[16]
Repositioning requires additional prepping, draping, and room positioning, which may significantly
increase costs, operative time, risk of contamination, possible graft migration, and anaesthesia related
complications [17-20] . Furthermore, the lateral position tends to be better tolerated by patients compared to
prone surgery and avoids many of the major complications associated with the prone position, such as
postoperative vision loss, cardiac arrest/complications, reduced pulmonary compliance, and nerve
palsies [21-23] .

Theoretical concerns regarding lateral position bilateral pedicle screw insertion have been raised, namely
inadequate correction of lumbar lordosis as well as difficulty with pedicle screw placement [24-26] . However,
several radiographic studies have reported unchanged lumbar lordosis between the prone and lateral
positions after LLIF [27,28] .

The literature regarding single position LLIF with posterior fixation is increasing, but it has not been
adopted universally yet . The purpose of this study was to review a single surgeon’s preliminary
[29]
experiences with single lateral position anterior-to-psoas lumbar interbody fusion with different techniques
of bilateral percutaneous pedicle screws and present perioperative results and complication rates.

METHODS
A retrospective review of collected data was performed on 35 consecutive patients who underwent single-
position antepsoas LIF with bilateral percutaneous pedicle screws and rod fixation at a single institution
during October 2018 to February 2020. Informed consent was obtained from all patients prior to the
procedure and once again confirmed at their 6-month follow-up appointment. After obtaining institutional