Single-position Prone Lateral Interbody Fusion is Associated With Improved Radiographic and Clinical Outcomes at One Year Compared With Single-position Lateral Interbody Fusion

Background. Recent studies highlight the increasing adoption of single-position prone lateral (SP-PL) and single-position lateral decubitus (SP-LD) in minimally invasive spine surgery (MISS) to reduce operative time, enhance patient safety, and improve surgical accessibility. Objective. To assess the differences between SP-PL and SP-LD achievement of optimal postoperative outcomes and postoperative complication rates. Study Design. Retrospective review of prospectively collected MIS database. Materials and Methods. Consecutive series of 152 patients with baseline (BL) and 1-year (1Y) postoperative radiographic/HRQL data were included. Patients placed in the SP-PL or SP-LD were isolated. Optimal outcome (OO) was defined as patients who experienced no complication requiring reoperation and achieved substantial clinical benefit (SCB) for NRS-leg or NRS-back. Means comparison analysis assessed differences in radiographic and clinical outcomes. ANCOVA and multivariable backward stepwise logistic regression were used to adjust for confounders. Results. Totally, 59 SP-PL and 93 SP-LD patients were included. At baseline, cohorts were comparable in terms of age, gender, BMI, and CCI. Perioperatively, SP-PL patients had a significantly lower operative time (207.22 vs . 317.5 min; P <0.001), LOS (3.1 vs . 3.6 d; P =0.033), EBL (244.5 vs . 376.3 mL; P =0.023), and demonstrated lower perioperative complication rate (25.4% vs . 41.9%; P =0.038). Multivariable analysis indicated that SP-PL patients had a lower likelihood of cardiac perioperative complications (OR: 0.012, 95% CI: 0.0–0.6; P =0.026). Immediate postoperatively, SP-PL has a greater degree of segmental lordosis improvement from L1–L2 to L5–S1 (all; P <0.05). SP-PL patients have a higher likelihood of achieving SCB NRS-back at 1Y (OR: 8.0, 95% CI: 1.5–42.0; P =0.014) and MCID NRS-leg at 1Y (OR: 4.6, 95% CI: 1.002–21.2; P =0.49). The SP-PL cohort had a significantly greater percentage of OO (96.6% vs . 78.5%; P =0.002) and a higher likelihood of achieving OO in adjusted analysis (OR: 10.6, 95% CI: 2.1–53.3; P =0.004). Conclusions. Patients placed in the SP-PL during minimally invasive spine surgery exhibit a reduced rate of perioperative complications, higher incidence of SCB, and a superior rate of achieving optimal outcome at the one-year follow-up. These findings underscore the SP-PL position as a potentially advantageous approach for minimally invasive lumbar fusion.