Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique

Area of Science:

• Spine Surgery
• Orthopedic Surgery
• Biomedical Engineering

Background:

• Lateral interbody fusion offers biomechanical advantages over transforaminal lumbar interbody fusion due to larger implant size and optimal positioning.
• Current lateral cage placement methods often involve staged procedures or lateral decubitus positions, limiting posterior access for decompression and pedicle screw fixation.

Purpose of the Study:

• To evaluate a prone single-position approach for simultaneous anterior and posterior lumbar spine access.
• To assess the feasibility of performing lateral lumbar interbody cage placement, direct posterior decompression, and pedicle screw fixation in one position.

Main Methods:

• A retrospective review of 10 cases utilizing a prone single-position approach for lumbar fusion.
• Employing 3D navigation for precise lateral spine access and interbody cage placement.
• Modifying traditional psoas muscle dilation with tubular retractors and lateral vertebral body retractor pins to mitigate lumbar plexus risks.

Main Results:

• Successful simultaneous access to both anterior and posterior lumbar spine elements was achieved.
• Lateral lumbar interbody cages, posterior decompression, and pedicle screw fixation were completed in a single operative position.
• The modified approach minimized risks to the lumbar plexus.

Conclusions:

• The prone single-position approach facilitates simultaneous anterior and posterior lumbar spine surgery, including lateral interbody fusion.
• This technique improves surgical efficiency and potentially reduces operative morbidity compared to traditional methods.
• 3D navigation and modified retraction techniques enhance safety and precision.