gms | German Medical Science

Objective: Anterior and lateral lumbar Interbody fusion techniques (ALIF and XLIF/LLIF) may enable a favorable degree of lordosis and indirect decompression than conventional techniques (PLIF and TLIF), in the lumbosacral transition in particular. Recently, the ALIF in lateral decubitus position (xALIF) has been introduced proposing to allow for additional multilevel XLIF without repositioning of the patient, yet data on the feasibility of the combined xALIF plus XLIF technique, its limitations and advantages is scarce. We report our first experience with the novel minimally invasive xALIF+XLIF technique in a single-position for multilevel fusion.

Methods: In a prospective observational case series we reviewed the clinical records of patients with multilevel lumbosacral degenerative disease who underwent combined xALIF of at least L5/S1 and XLIF of at least one additional level from L1 to L5 between 03/2020 – 12/2021 at our spine center. A retrospective matched patient cohort treated conventionally with corresponding multilevel TLIF served as reference. All patients received bilateral pedicle screw placement. Pre- and postoperative standing radiographs of the spine were compared by Surgimap^®. Statistics were expressed as mean ± standard error of the mean.

Results: The combined xALIF plus XLIF approach was performed in six cases so far (mean 2.2 segments per patient). A gain of lordosis per segm. was noted by mean 8 ±1.7° while the matched retrospective TLIF cohort demonstrated a mean of 2 ±1.8°. The increase of intercorporal height at the trailing edge amounted to mean 2.2 ±0.9 mm in the xALIF+XLIF group (1.4 ±1.2 mm in the TLIF cohort). The mean intraoperative blood loss with 263 ±80ml per segm. in the xALIF+XLIF patients appeared relatively less than in the TLIF cohort (595.8 ±143.8 ml/segm.). The mean surgery duration of the xALIF+XLIF treated patients was 146 ±16 min./segm. (TLIF cohort: 159.4 ±18.2 min./segm.). The xALIF+XLIF patients stayed 10.2 ±2.5 d in the hospital (TLIF cohort: 12.5 ±5 d). No increased incidence of adverse events or complications was noted due to the xALIF+XLIF approach compared to TLIF surgery.

Conclusion: We found the novel combined xALIF plus XLIF technique in a single lateral position for the lumbosacral multilevel fusion to be feasible, safe and promising with regard to sparing blood loss and favorable radiographic results in reference to multilevel TLIF. Further studies are needed with regard to long term clinical outcome.