Lumbar lateral interbody fusion: step-by-step surgical technique and clinical experience.

Lateral lumbar interbody fusion (LLIF) is a minimally invasive surgical approach used to treat a variety of degenerative and deformity conditions of the lumbar spine such as advanced degenerative disease, degenerative scoliosis, foraminal and central stenosis. It has emerged as an alternative to the traditional posterior and anterior lumbar approaches with some potential benefits such as lower blood loss and shorter hospital stay. In this article, we provide our single institutional surgical experience including main indications and contraindications, a step-by-step surgical technique description, a detailed preoperative imaging assessment with a focus on magnetic resonance imaging (MRI) psoas anatomy, operative room (OR) setup and patient positioning. A descriptive surgical technical note of the following steps is provided: positioning and fluoroscopic confirmation, incision and intraoperative level confirmation, discectomy and endplate preparation, implant size selection and insertion and final fluoroscopic control, hemostasis check and wound closure along with an instructional surgical video with tips and pearls, postoperative patient care recommendations, common approach-related complications, along with our historical clinical institutional group experience. Finally, we summarize our research experience in this surgical approach with a focus on LLIF as a standalone procedure. Based on our experience, LLIF can be considered an effective surgical technique to treat degenerative lumbar spine conditions. Proper patient selection is mandatory to achieve good outcomes. Our institutional experience shows higher fusion rates with good clinical outcomes and a relatively low rate of complications.
Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-23-54/coif). AAS reports royalties from Ortho Development, Corp.; private investments for Vestia Ventures MiRUS Investment, LLC, ISPH II, LLC, ISPH 3, LLC, HS2, LLC, HSS ASC Development Network, LLC and VBros Venture Partners X Centinel Spine; consulting fee from Clariance, Inc., Kuros Biosciences AG, DePuy Synthes Products, Inc., Ortho Development Corp and Medical Device Business Service, Inc.; speaking and teaching arrangements of DePuy Synthes Products, Inc.; membership of scientific advisory board of Clariance, Inc., and Kuros Biosciences AG; and trips/travel of Medical Device Business; research support from Spinal Kinetics, Inc., outside the submitted work. FPC reports royalties from NuVasive, Inc. and Accelus; private investments for 4WEB Medical/4WEB, Inc., Healthpoint Capital Partners, LP, ISPH II, LLC, ISPH 3 Holdings, LLC, Ivy Healthcare Capital Partners, LLC, Medical Device Partners II, LLC, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Tissue Differentiation Intelligence, LLC, VBVP VI, LLC, VBVP X, LLC (Centinel) and Woven Orthopedics Technologies; consulting fees from 4WEB Medical/4WEB, Inc., Accelus; DePuy Synthes Spine, NuVasive, Inc. and Spine Biopharma, LLC; membership of scientific advisory board/other office of Healthpoint Capital Partners, LP, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, and Woven Orthopedic Technologies; and research support from 4WEB Medical/4WEB, Inc., Mallinckrodt Pharmaceuticals, Camber Spine, and Centinel Spine; scientific support from Healthpoint Capital Partners, LP; outside the submitted work. FPG reports royalties from Lanx, Inc., and Ortho Development Corp.; private investments for Centinel Spine, and BCMID; stock ownership of Healthpoint Capital Partners, LP; and consulting fees from NuVasive, Inc., and DePuy Synthes Spine, outside the submitted work. APH reports research support from Expanding Innovations, Inc. and Kuros Biosciences BV; and fellowship support from NuVasive, Inc. and Kuros Biosciences BV, outside the submitted work. DRL reports royalties from NuVasive, Inc. and Stryker; private investments from HS2, LLC, Woven Orthopedic Technologies, Vestia Ventures MiRus Investiment LLC, ISPH, LLC; consulting fee from Depuy Synthes, Vizeon, Inc.; scientific advisory board from Remedy Logic; and research support from Medtronic. GS receives consulting fees from Stryker and Camber spine. The other authors have no conflicts of interest to declare.
(2023 Journal of Spine Surgery. All rights reserved.)