Lateral decubitus anterior exposure of the L4–5 disc maintains safety compared with supine positioning
Year: 2024
Type: article
Study design: Observational Study
Abstract: Background: Anterior retroperitoneal lumbar spinal exposure has traditionally been performed in the supine position (SUP) to access the L4–L5 and L5–S1 disc spaces where lateral approaches may be unsafe. However, advancements in lateral single position surgery have resulted in advocacy for anterior L4–5 disc access in the lateral decubitus position (LAT). While L5–S1 access in the lateral position is well-described, no series of L4–5 anterior access in the lateral position has been published. The study aims to evaluate the safety of anterior lumbar exposure at the L4–5 disc level in the LAT compared to the SUP. Methods: A multi-center retrospective study of patients who underwent anterior retroperitoneal lumbar exposure involving the L4–5 disc level were classified according to patient positioning: (I) LAT or (II) SUP. Results: One hundred and forty patients were included, of which 65 LAT and 75 SUP patients. Two hundred and thirty-eight anterior levels were exposed, including 113 levels performed in lateral and 125 levels in supine. Mean anterior levels fused was similar (1.74 vs. 1.67 levels, P=0.37). Significantly more LAT patients underwent additional lateral lumbar interbody fusion (LLIF) (21.50% vs. 0.00%, P<0.001). A larger proportion of LAT patients underwent surgery for spinal deformity (21.50% vs. 6.70%, P=0.01) and planned staged procedures (21.50% vs. 6.70%, P=0.01). Intraoperative complication rates were similar (3.10% vs. 4.00%, P=0.77), including similar vascular injury rates (1.50% vs. 0.00%, P=0.28) and no visceral injury. Postoperative complications (15.40% vs. 38.70%, P=0.002) were significantly lower in the LAT group, however major complications (6.20% vs. 13.30%, P=0.16) were similar between groups. Fewer LAT patients experienced postoperative ileus (0.00% vs. 6.70%, P=0.03). The rate of reoperation within 30 days (3.10% vs. 6.70%, P=0.33) and 90 days (3.10% vs. 10.70%, P=0.09) were similar between groups. Conclusions: Anterior lumbar spinal exposure of the L4–5 disc in the LAT is safe compared to supine exposure, despite higher case complexity in the lateral position.
Source: Journal of Spine Surgery
DOI: 10.21037/jss-24-34
Authors: Nam V. Huynh, J. Alex Thomas, Leon Eisen, Domenic Robinson, Mark Medley, Aaron J. Buckland
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4402686489