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Anterior column reconstruction of the lumbar spine in the lateral decubitus position: anatomical and patient-related considerations for ALIF, anterior-to-psoas, and transpsoas LLIF approaches

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Abstract

Purpose

Circumferential (AP) lumbar fusion surgery is an effective treatment for degenerative and deformity conditions of the spine. The lateral decubitus position allows for simultaneous access to the anterior and posterior aspects of the spine, enabling instrumentation of both columns without the need for patient repositioning. This paper seeks to outline the anatomical and patient-related considerations in anterior column reconstruction of the lumbar spine from L1–S1 in the lateral decubitus position.

Methods

We detail the anatomic considerations of the lateral ALIF, transpsoas, and anterior-to-psoas surgical approaches from surgeon experience and comprehensive literature review.

Results

Single-position AP surgery allows simultaneous access to the anterior and posterior column and may combine ALIF, LLIF, and minimally invasive posterior instrumentation techniques from L1–S1 without patient repositioning. Careful history, physical examination, and imaging review optimize safety and efficacy of lateral ALIF or LLIF surgery. An excellent understanding of patient spinal and abdominal anatomy is necessary. Each approach has relative advantages and disadvantages according to the disc level, skeletal, vascular, and psoas anatomy.

Conclusions

A development of a framework to analyze these factors will result in improved patient outcomes and a reduction in complications for lateral ALIF, transpsoas, and anterior-to-psoas surgeries.

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Authors and Affiliations

  1. NYU Langone Orthopedic Hospital, New York, NY, USA

    Aaron J. Buckland, Carlos Leon & Leon Eisen

  2. Department of Neurosurgery, NYU Langone Medical Center, 462 1st Avenue, Suite 7S4, New York, NY, 10016, USA

    Kimberly Ashayeri

  3. Austin Spine Surgery, Austin, TX, USA

    Ivan Cheng

  4. Atlantic Neurosurgical and Spine Specialists, Wilmington, NC, USA

    J. Alex Thomas

  5. Oklahoma Sports, Science and Orthopaedics, Oklahoma City, OK, USA

    Brett Braly

  6. Division of Spine Surgery, New England Baptist Hospital, Boston, MA, USA

    Brian Kwon

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Correspondence to Kimberly Ashayeri.

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Conflicts of interest

J. Alex Thomas is a consultant for NuVasive. Brett Braly is a consultant for Stryker and NuVasive. Ivan Cheng is a consultant for NuVasive and Globus Medical. Brian Kwon is a consultant for NuVasive. Themistocles S. Protopsaltis is a consultant for Altus Partners, Globus Medical, NuVasive, and Zimmer Biomet. Aaron J. Buckland is a consultant for NuVasive, Biedermann Motech, Medtronic, Evolution Spine, Altus Partners, and Zimmer Biomet.

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Buckland, A.J., Ashayeri, K., Leon, C. et al. Anterior column reconstruction of the lumbar spine in the lateral decubitus position: anatomical and patient-related considerations for ALIF, anterior-to-psoas, and transpsoas LLIF approaches. Eur Spine J 31, 2175–2187 (2022). https://doi.org/10.1007/s00586-022-07127-9

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