Lumbar XLIF and Bilateral Percutaneous Pedicle Screw Fixation Performed all in Lateral Position

Abstract

Introduction Evaluation of the feasibility, technical difficulty, and clinical results in performing combined lumbar XLIF and bilateral percutaneous pedicle screw fixation done all in lateral position. Lumbar XLIF and bilateral percutaneous pedicle fixation is a valuable minimally invasive approach for achieving a useful and solid lumbar circumferential fusion in selected cases. Nonetheless, until today a change of the position of the patient on the operating table from lateral to prone was used. Theoretically, performing both approaches in the same position would significantly reduce the time of surgery. Patients and Methods A total of 10 consecutive patients were submitted to a circumferential fusion done in the same, lateral, and position. There were six female and four male patients, mean age 52 years. Low back pain and degenerative disc disease were the main patient's complaint and pathology, respectively. Patients were followed up for surgery length and walk out of bed timing and compared with the patients done previously with change of position. Clinical outcome was evaluated with VAS and ODI scores. Results Four patients performed a two-level circumferential fusion (L3–L5) whereas six patients performed the procedure on a single level (four on L4–L5 and two on L3–L4). Mean surgical time was 79 ( ± 14) minutes (29 for XLIF and 50 for pedicle fixation) and 114 ( ± 21) minutes (54 for XLIF and 60 for pedicle fixation) for 1 and 2 level circumferential fusion, respectively. Average time lap between the XLIF part and pedicle screw part of the procedure was 4 minutes. As compared with the usual approach with the change of position, approximately 20 minutes were saved. There was no significant difference in walk out of bed timing as well as no difference was found for clinical outcome scores (VAS and ODI). No additional complications were noted in this group of patients as compared with the patients operated previously with the change of position. Conclusion Lumbar circumferential fusion with XLIF and bilateral percutaneous pedicle screw fixation performed in lateral position seems a useful modification of the classical method done in two different positions. The main advantage is time saving. Technical challenge in performing the procedure in lateral position is slightly more demanding because of the different patient orientation; however, the learning curve is short and after a few cases, the timing of the approaches between prone and lateral position equals. No differences on clinical outcomes and complication rates were noted.