Nikolay L Martirosyan1, Juan S Uribe2, Blake M Randolph3, Russell I Buchanan3. 1. Department of Neurosurgery, Allen Memorial Hospital, UnityPoint Clinic, Waterloo, Iowa, USA. Electronic address: Nikolay.Martirosyan@unitypoint.org. 2. Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. 3. Department of Neurosurgery, Allen Memorial Hospital, UnityPoint Clinic, Waterloo, Iowa, USA.
Abstract
OBJECTIVE: The transpsoas lateral lumbar interbody fusion (LLIF) is a commonly used technique to manage various spinal conditions. LLIF is often performed in combination with posterior lumbar instrumentation, which requires patient repositioning or staging of the procedure. Here we present a step-by-step detailed description of a prone LLIF using an intraoperative laser level to guide orthogonal insertion of instrumentation. METHODS: A 57-year-old man with history of L4-S1 instrumentation, who developed symptomatic adjacent L3L/4 level stenosis and sagittal plane imbalance. The single position prone lateral lumbar interbody fusion with posterior fixation was chosen in order to minimize operative room time and optimize lumbar lordosis (LL) correction. RESULTS: The patient was positioned prone on a Jackson table. This position allowed for improved LL correction. A self-leveling laser line ensured ideal orthogonal use of instrumentation. The patient had improvement of symptoms immediately postoperatively and was discharged home on postoperative day 2 without complications. CONCLUSIONS: The single position prone LLIF with posterior fixation offers a shorter operative room time by eliminating necessity to reposition the patient between stages of operation. The prone position of the patient optimizes LL correction. Further experience with this approach will allow for refining of the technique to overcome its limitations and facilitate its utilization.
OBJECTIVE: The transpsoas lateral lumbar interbody fusion (LLIF) is a commonly used technique to manage various spinal conditions. LLIF is often performed in combination with posterior lumbar instrumentation, which requires patient repositioning or staging of the procedure. Here we present a step-by-step detailed description of a prone LLIF using an intraoperative laser level to guide orthogonal insertion of instrumentation. METHODS: A 57-year-old man with history of L4-S1 instrumentation, who developed symptomatic adjacent L3L/4 level stenosis and sagittal plane imbalance. The single position prone lateral lumbar interbody fusion with posterior fixation was chosen in order to minimize operative room time and optimize lumbar lordosis (LL) correction. RESULTS: The patient was positioned prone on a Jackson table. This position allowed for improved LL correction. A self-leveling laser line ensured ideal orthogonal use of instrumentation. The patient had improvement of symptoms immediately postoperatively and was discharged home on postoperative day 2 without complications. CONCLUSIONS: The single position prone LLIF with posterior fixation offers a shorter operative room time by eliminating necessity to reposition the patient between stages of operation. The prone position of the patient optimizes LL correction. Further experience with this approach will allow for refining of the technique to overcome its limitations and facilitate its utilization.