Introduction: The prone lateral single-position (PL-SP) approach has recently evolved as a patient positioning option with circumferential spine access. It is reported to improve on the lateral decubitus position, with the added ability for decompression and posterior instrumentation, and decreased operative time (due to the eliminated need for intra-operative patient repositioning). Its utility in revision spine fusion remains understudied.
Methods: We included patients undergoing thoracolumbar spine fusion with minimum complete 2-year clinical and radiographic data. Patients who had undergone primary or revision surgery via the PL approach were isolated. Means comparisons tests analyzed differences in outcomes between patient groups, with controlled analyses accounting for any baseline differences.
Results: 152 patients were included in this study. The mean age was 59±11 yrs, mean body mass index was 30.8 ± 6.2 kg/m2 and the mean Charlson comorbidity index was 2.8±1.9. 57.4% of patients were male. 31% underwent revision surgery via the prone lateral approach. Revision surgery indication was predominantly for adjacent segment disease and/or pseudoarthrosis. There were no differences at baseline between primary and revision surgery patients in demographic, clinical, radiographic and functional metrics (all p>0.05). Revision surgery patients had longer operative times (mean 371.3 minutes vs 272.3 minutes, p=0.010). No other peri-operative characteristics were significantly different. Rates of postoperative complications, reoperations and readmissions for any reason were similar between both groups (all p>0.05). Similarly, both groups achieved equivocal outcomes in health-related quality of life metrics.
Conclusion : The prone lateral (PL) patient positioning modality continues to be used increasingly during spine fusion surgery. Patients undergoing revision surgery using the PL position demonstrate similar outcomes to primary surgery patients, despite understandably increased operative times. Larger studies with longer term follow-up will aid with reinforcing the findings of this study.
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