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Single-position circumferential lumbar spinal fusion: an overview of terminology, concepts, rationale and the current evidence base

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Abstract

Purpose

To provide definitions and a conceptual framework for single position surgery (SPS) applied to circumferential fusion of the lumbar spine.

Methods

Narrative literature review and experts’ opinion.

Results

Two major limitations of lateral lumbar interbody fusion (LLIF) have been (a) a perceived need to reposition the patient to the prone position for posterior fixation, and (b) the lack of a robust solution for fusion at the L5/S1 level. Recently, two strategies for performing single-position circumferential lumbar spinal fusion have been described. The combination of anterior lumbar interbody fusion (ALIF) in the lateral decubitus position (LALIF), LLIF and percutaneous pedicle screw fixation (pPSF) in the lateral decubitus position is known as lateral single-position surgery (LSPS). Prone LLIF (PLLIF) involves transpsoas LLIF done in the prone position that is more familiar for surgeons to then implant pedicle screw fixation. This can be referred to as prone single-position surgery (PSPS). In this review, we describe the evolution of and rationale for single-position spinal surgery. Pertinent studies validating LSPS and PSPS are reviewed and future questions regarding the future of these techniques are posed. Lastly, we present an algorithm for single-position surgery that describes the utility of LALIF, LLIF and PLLIF in the treatment of patients requiring AP lumbar fusions.

Conclusions

Single position surgery in circumferential fusion of the lumbar spine includes posterior fixation in association with any of the following: lateral position LLIF, prone position LLIF, lateral position ALIF, and their combination (lateral position LLIF+ALIF). Preliminary studies have validated these methods.

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

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

    J. Alex Thomas

  2. HVC Hospital and Columna Institute, Belo Horizonte, Brazil

    Cristiano Menezes

  3. Melbourne Orthopaedic Group, Melbourne, VIC, Australia

    Aaron J. Buckland

  4. Georgia Spine and Neurosurgery Center, Atlanta, Georgia

    Kaveh Khajavi

  5. Department of Neurosurgery, New York University, New York, NY, USA

    Kimberly Ashayeri

  6. The Spine Clinic of Oklahoma City, Oklahoma City, OK, USA

    Brett A. Braly

  7. New England Baptist Hospital, Boston, MA, USA

    Brian Kwon

  8. Austin Spine, Austin, TX, USA

    Ivan Cheng

  9. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Pedro Berjano

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Corresponding author

Correspondence to J. Alex Thomas.

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Conflict of interest

Dr. Thomas is a consultant for and receives institutional research support from NuVasive, Inc. (consulting fees and royalties) and a stockholder in TrackX technologies. Dr. Menezes is a consultant for NuVasive, Inc. (consulting fees, research grants, education and product development), a member of AOSPINE Education, and serves as the Brazilian Spine Society President. Dr. Buckland is a consultant for and receives institutional research support from NuVasive, Inc (consulting fees and royalties). Dr. Khajavi is a consultant for NuVasive, Inc. (consulting fees, royalties, education and product development). Dr. Ashayeri has no disclosures. Dr. Kwon is a consultant for NuVasive, Inc (consulting fees and royalties) and Prosidyan (consulting and stock ownership). Dr. Braly is a paid consultant for Stryker. Dr. Cheng is a consultant for NuVasive, Inc. (consulting, royalties), Globus Medical (Royalties), Spine Wave (Royalties), Surgalign (Consulting), Notogen (Stock, Advisory Board), Cytonics (Stock) and SpinalCyte (Stock).

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Thomas, J.A., Menezes, C., Buckland, A.J. et al. Single-position circumferential lumbar spinal fusion: an overview of terminology, concepts, rationale and the current evidence base. Eur Spine J 31, 2167–2174 (2022). https://doi.org/10.1007/s00586-022-07229-4

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  • DOI: https://doi.org/10.1007/s00586-022-07229-4

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