Supine lateral lumbar interbody fusion: cadaveric proof of principle for simultaneous anterior and lateral approaches

Single-position anterior and lateral lumbar fusion in the supine position: a novel technique for multi-level arthrodesis

OBJECTIVE

Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are common techniques that typically require staged procedures when performed in combination. Interest is emerging in single-position surgery to increase operative efficiency. We report a novel surgical technique, supine extended reach (SupER) lateral fusion, to perform ALIF and LLIF with the patient in a single supine position.

METHODS

A man in his fifties presented with degenerative levoscoliosis, spondylolisthesis, sagittal-plane deformity, and progressive low back pain. He was offered L3-S1 anterolateral fusion.

RESULTS

With the patient supine, a left abdominal paramedian incision was performed to gain anterior retroperitoneal access, and standard L5-S1 and L4-5 ALIFs were performed. The anterior incision was used for direct visualization, retraction, and bimanual dissection. A left lateral incision was then made to perform an L3-4 LLIF. The patient subsequently underwent a second-stage L3-S1 posterior percutaneous fixation. The patient tolerated the procedures well, without complications. Postoperative radiograph findings confirmed acceptable implant positioning. The patient was discharged home in stable condition and was doing well at follow-up.

CONCLUSION

This case description is the first report of the SupER technique, which allows incorporation of anterior and lateral fusion constructs at adjacent levels without changing patient positioning. Many surgeons believe the ALIF to be the most powerful technique for achieving lordosis, and this technique enables concomitant lateral access in a supine position. It can also be used as an alternative strategy when anterior access to the disc space is unobtainable. Further clinical investigation of this technique is warranted.