Safety Profile, Surgical Technique, and Early Clinical Results for Simultaneous Lateral Lumbar Interbody Fusion and Anterior Lumbar Interbody Fusion in a Lateral Position

Study Design: Description of surgical technique and retrospective review. Objective: To describe a novel surgical technique for multilevel lumbar fusion and describe early clinical results. Summary of Background Data: Patients with multilevel lumbar spinal stenosis and adult degenerative scoliosis often require multilevel interbody placement to achieve indirect decompression and lordosis. We describe a case series of patients treated with simultaneous lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF) at L5-S1. Methods: We retrospectively reviewed a consecutive series of patients treated for multilevel lumbar spinal stenosis with simultaneous ALIF and LLIF with at least 3-month follow-up. All patients received supplemental percutaneous bilateral pedicle screw placement as well. We measured on preoperative radiographs their lumbar lordosis, pelvic incidence, and L5-S1 lordosis. Intraoperative factors such as operative time, estimated blood loss, fluids provided, number of levels fused, and whether a trainee was present during the procedure were all recorded. Results: There were 15 patients included within our case series (69.5, 4 F). There were no reported intraoperative vascular or neurological complications in 15 cases. The operative time for the cases ranged from 2.7 to 8.4 hours (average=5.2 +/- 1.9 h). The average lordosis gained at L5-S1 was 8.6 +/- 3.0 degrees and the average lumbar lordosis gained was 14.7 +/- 6.4 degrees. The average PI-LL mismatch went from 22.4 +/- 13.3 degrees preoperative to 7.8 +/- 10.2 degrees postoperative. One patient had a postoperative complication of a sacral fracture requiring placement of a pelvic screw for a L2-pelvis fusion. There were 8 patients with 4+ levels of fusion. For this cohort of patients, the average lumbar lordosis gained was 16.0 +/- 7.5 degrees and the average PI-LL mismatch went from 24.7 +/- 16.3 degrees preoperative to 8.8 +/- 12.9 degrees postoperative. For the patients with 4+ levels of fusion, the average operative time was 5.9 +/- 1.8 hours. Conclusions: We have described our early positive results with simultaneous LLIF/ALIF surgery for treatment of lumbar degenerative conditions.