Single Position Lateral Anterior Lumbar Interbody Fusion at L5/S1

Anterior lumbar interbody fusion (ALIF) is an established surgical approach for spinal fusion, offering distinct advantages in restoring lumbar lordosis, indirectly decompressing neural elements, and facilitating high fusion rates because of the increase in the fusion surface area. Traditionally, ALIF is performed with the patient in a supine position, necessitating repositioning for additional posterior interventions, which increases operative time, anesthetic time, and complexity. The recent development of single position lateral ALIF (SPL-ALIF) enables anterior and posterior access without repositioning, enables gravity facilitated retroperitoneal access, and optimizes surgical efficiency, particularly in cases necessitating multilevel anterior column fusion. The current review comprehensively examines SPL-ALIF at the L5-S1 level, presenting technical considerations and comparative benefits over traditional techniques. The approach has demonstrated significant reductions in operative time, blood loss, and postoperative ileus, with equivalent radiographic outcomes compared with supine ALIF. Furthermore, SPL-ALIF has been evidenced to have a similar safety profile to supine ALIF with equivalent vascular, abdominal, and neurological complications, as well as comparable revision rates between the two procedures. However, SPL-ALIF is not without limitations. The technique may be less effective in cases requiring direct decompression or in patients with complex vascular anatomy or extensive retroperitoneal scarring. These challenges necessitate careful patient selection to optimize outcomes and minimize intraoperative risks. Future studies are warranted to validate the clinical benefits of SPL-ALIF, particularly concerning fusion rates, patient-reported outcomes, and complication profiles, thereby solidifying its role in the evolving landscape of minimally invasive spine surgery.