Perioperative and Radiographic Outcomes Between Single-Position Surgery (Lateral Decubitus) and Dual-Position Surgery...

Area of Science:

• Spine surgery
• Minimally invasive procedures
• Degenerative lumbar pathologies

Background:

• Lateral lumbar interbody fusion (LLIF) and percutaneous posterior screw fixation (PPSF) are established techniques for degenerative lumbar conditions.
• Dual-position (DP) surgery requires patient repositioning, while single-position (SP) surgery is performed entirely from the lateral decubitus position.
• The optimal surgical approach for LLIF and PPSF remains a subject of ongoing debate.

Purpose of the Study:

• To compare perioperative outcomes between single-position (SP) and dual-position (DP) lumbar surgery for LLIF and PPSF.
• To evaluate differences in operative time, hospital stay, blood loss, radiation exposure, and radiographic parameters.
• To assess complication and reoperation rates associated with SP versus DP lumbar surgery.

Main Methods:

• A meta-analysis was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Medline and Scopus databases were searched for relevant studies from inception to November 11, 2021.
• Six studies comprising 502 patients in the SP group and 447 in the DP group were included in the analysis.

Main Results:

• Single-position (SP) surgery demonstrated significantly lower operative times (mean difference -86.1 minutes) and hospital stays (mean difference -1.6 days) compared to dual-position (DP) surgery.
• No significant differences were observed in intraoperative blood loss, radiation doses, lumbar lordosis, pelvic incidence-lumbar lordosis mismatch, complication rates, or reoperation rates between the SP and DP groups.
• While SP showed trends towards lower blood loss and radiation, these did not reach statistical significance.

Conclusions:

• Single-position (SP) lumbar surgery is associated with reduced operative time and length of hospital stay compared to dual-position (DP) approaches for LLIF and PPSF.
• Despite potential benefits in efficiency, SP and DP techniques showed comparable rates of intraoperative blood loss, radiation exposure, radiographic outcomes, complications, and reoperations.
• The findings suggest SP surgery offers advantages in resource utilization without compromising patient safety or key clinical outcomes.