. 2022 Sep;31(9):2167-2174.
Epub 2022 Aug 1.
J Alex Thomas et al.
Eur Spine J.
To provide definitions and a conceptual framework for single position surgery (SPS) applied to circumferential fusion of the lumbar spine.
Narrative literature review and experts’ opinion.
Two major limitations of lateral lumbar interbody fusion (LLIF) have been (a) a perceived need to reposition the patient to the prone position for posterior fixation, and (b) the lack of a robust solution for fusion at the L5/S1 level. Recently, two strategies for performing single-position circumferential lumbar spinal fusion have been described. The combination of anterior lumbar interbody fusion (ALIF) in the lateral decubitus position (LALIF), LLIF and percutaneous pedicle screw fixation (pPSF) in the lateral decubitus position is known as lateral single-position surgery (LSPS). Prone LLIF (PLLIF) involves transpsoas LLIF done in the prone position that is more familiar for surgeons to then implant pedicle screw fixation. This can be referred to as prone single-position surgery (PSPS). In this review, we describe the evolution of and rationale for single-position spinal surgery. Pertinent studies validating LSPS and PSPS are reviewed and future questions regarding the future of these techniques are posed. Lastly, we present an algorithm for single-position surgery that describes the utility of LALIF, LLIF and PLLIF in the treatment of patients requiring AP lumbar fusions.
Single position surgery in circumferential fusion of the lumbar spine includes posterior fixation in association with any of the following: lateral position LLIF, prone position LLIF, lateral position ALIF, and their combination (lateral position LLIF+ALIF). Preliminary studies have validated these methods.
ALIF; LLIF; Prone-lateral; Single-position; XLIF.
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Single position lateral decubitus anterior lumbar interbody fusion (ALIF) and posterior fusion reduces complications and improves perioperative outcomes compared with traditional anterior-posterior lumbar fusion.
Ashayeri K, Leon C, Tigchelaar S, Fatemi P, Follett M, Cheng I, Thomas JA, Medley M, Braly B, Kwon B, Eisen L, Protopsaltis TS, Buckland AJ.
Ashayeri K, et al.
Spine J. 2022 Mar;22(3):419-428. doi: 10.1016/j.spinee.2021.09.009. Epub 2021 Sep 30.
Spine J. 2022.
Prone Single-Position Lateral Lumbar Interbody Fusion With Posterior Decompression and Pedicle Screw Fixation for the Treatment of Grade II Spondylolisthesis: 2-Dimensional Operative Video.
Naeem K, Farber SH, Bhargava M, Porter RW.
Naeem K, et al.
Oper Neurosurg (Hagerstown). 2021 Jul 15;21(2):E119-E120. doi: 10.1093/ons/opab107.
Oper Neurosurg (Hagerstown). 2021.
Spinal exposure for anterior lumbar interbody fusion (ALIF) in the lateral decubitus position: anatomical and technical considerations.
Buckland AJ, Leon C, Ashayeri K, Cheng I, Alex Thomas J, Braly B, Kwon B, Maglaras C, Eisen L.
Buckland AJ, et al.
Eur Spine J. 2022 Sep;31(9):2188-2195. doi: 10.1007/s00586-022-07227-6. Epub 2022 May 12.
Eur Spine J. 2022.
Single position circumferential fusion improves operative efficiency, reduces complications and length of stay compared with traditional circumferential fusion.
Buckland AJ, Ashayeri K, Leon C, Manning J, Eisen L, Medley M, Protopsaltis TS, Thomas JA.
Buckland AJ, et al.
Spine J. 2021 May;21(5):810-820. doi: 10.1016/j.spinee.2020.11.002. Epub 2020 Nov 13.
Spine J. 2021.
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Single-position circumferential lumbar spinal fusion: an overview of terminology, concepts, rationale and the current evidence base – PubMed
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Review . 2022 Sep;31(9):2167-2174. doi: 10.1007/s00586-022-07229-4. Epub 2022 Aug 1. Affiliations Affiliations 1 Atlantic Neurosurgical and Spine Specialists, Wilmington, NC, USA. Alext9999@gmail.com. 2 HVC Hospital and Columna Institute, Belo Horizonte, Brazil. 3 Melbourne Orthopaedic Group, Melbourne, VIC, Australia. 4 Georgia Spine and Neurosurgery Center, Atlanta, Georgia. 5 Department of Neurosurgery, New York University, New York,…
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