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Choi et al. Mini-invasive Surg 2021;5:43 https://dx.doi.org/10.20517/2574-1225.2021.73 Page 9 of 14

Figure 2. Patient 27. Grade B (2-4 mm) of right hand downside L3 pedicle screw. (A) Postoperative coronal computerized tomography
slice, (B) postoperative sagittal computerized tomography slice.

Other complications included delays of the transfer due to bed shortages at rehabilitation centres (6),
pneumonia (1), respiratory distress (1), prolonged intensive care unit stay (1), delirium (2), new-onset atrial
fibrillation (1), wound infection (1), urinary tract infection (1) and urosepsis (1).

DISCUSSION
Providing high-quality, value-based treatments is essential for the patient’s benefit and sustainability of
healthcare systems. Alternative forms of surgical techniques with low operative times and procedural
morbidities decrease hospital costs, shorten recovery times and improve patient experiences [34-36] .
Traditionally, the prone position is utilized by spine surgeons to gain access to the spinal column [21-23] .
Recently, there has been increasing interest in completing LLIF in the single lateral position, and reports of
reduced operative times and consequent cost reductions have been made [17,18,37] . This study builds on the
[18]
[17]
previous work of Blizzard et al. and Ziino et al. , and found favourable outcomes for primary endpoints
including, screw accuracy, complication rates, surgical efficiency, and lordosis correction.
Pedicle screw misplacement rates for conventional prone position techniques vary greatly in the literature,
ranging from 5% to 41% [38-42] . It represents the significant heterogeneity in the radiographic modalities and
grading schemes used in studies to assess screw accuracy. Breach rates of 1.5% to 14.3% were found when
[17]
the literature was limited to studies investigating screw accuracy rates with postoperative CT imaging .
Currently, some papers have assessed pedicle screw accuracy in single position LLIF, and Blizzard et al.
[17]
[30]
reported an overall breach rate of 5.1%, with 1.2% of screws between 2-4 mm, whilst Sellin et al. , reported
a 14% (2/14) overall breach rate in their 4 patient case series. Although there is no comparison cohort in the
current study, the 4.7% overall breach rate and 0.7% grade B (2-4 mm) breach rate is consistent with the
published literature. Moreover, the surgeon used the different techniques available, including robots,
navigation, and fluoroscopic guided percutaneous pedicle screws. It can be helpful as robots and navigation
are unable to use in every operating theatre in the world.