A Multi-institutional Comparison of Lateral vs. Prone Lateral Interbody Fusion in the Correction of Spine Deformity

Introduction: Lateral spine surgery techniques have gained popularity for treating spine deformities due to their ability to achieve substantial correction with a minimal surgical footprint. However, integrating these techniques with anterior and posterior approaches often requires repositioning the patient during surgery, leading to inefficiencies and increased costs. The newer prone lateral technique offers a potential solution to enhance surgical efficiency and outcomes. This study compares the clinical and radiographic outcomes of these two approaches in managing adult spinal deformity.

Methods: We conducted a retrospective review of spine deformity correction cases using either the lateral (n=31) or prone lateral (n=94) approach across 11 institutions. Deformity was defined by a preoperative sagittal vertical axis (SVA) > 5cm or a pelvic incidence-lumbar lordosis (PI-LL) mismatch > 10. Analyses included demographic, perioperative, spinopelvic parameters, and patient-reported outcomes data.

Results: Both lateral and prone lateral approaches led to significant improvements in lumbar lordosis (p < 0.0001 for both groups) and segmental lordosis (p=0.008 vs p=0.005 for lateral and prone lateral, respectively). However, only the prone lateral technique resulted in significant improvement in pelvic tilt (p < 0.0001) and PI-LL mismatch (p < 0.0001). Patients in both groups showed significant preoperative-to-postoperative improvements in Visual Analog Scale (VAS) scores (p < 0.0001).

Conclusion : While lateral spine surgery remains a standard for deformity correction with comparable pain improvements, the prone lateral approach may provide superior spinopelvic parameter corrections, potentially offering an even more effective option for spine deformity correction.