Assessment of the Change in Degree of Segmental Lordosis in Prone and Lateral Decubitus Patient Positioning in Lateral Interbody Fusion Techniques: A Systematic Review of Literature

Introduction: In lumbar fusion surgery, restoring lordosis has been a consistent challenge. Improved postoperative lumbar lordosis leads to reduced back pain, fewer post-surgery disabilities, decreased adjacent segment degeneration, and enhanced surgical outcomes. Traditional fusion techniques often struggle to achieve optimal segmental lordosis. The emerging prone-positioned lateral lumbar interbody fusion technique facilitates increased lordosis through positioning. The authors aimed to elucidate the differences in segmental lordosis outcomes between the prone and lateral decubitus positioning.

Methods: The authors performed a PRISMA guidelines-based systematic review of the literature. Only articles that reported pre and postoperative degrees of segmental lordosis with patient positioning in prone or lateral decubitus lateral lumbar interbody fusion were included. Statistical analysis was performed using python.

Results: The search resulted in 442 studies, 21 were included. 994 patients were identified with 847 treated from a lateral decubitus position and 147 treated from prone positioning. Mean operative time in the lateral decubitus group was significantly shorter than in the prone lateral group (150 v. 223, p< 0.001). Estimated blood loss was also significantly lower in the lateral decubitus position than prone (173 v. 89, p< 0.001). The average degree of improvement in segmental lordosis from the prone positioning group was 6.4 degrees, compared with 2.6 degrees in the lateral decubitus positioning group (p < 0.001). Similarly, the improvement in global lordosis was 4.9 degrees in the prone group compared to 2.5 degrees in the lateral decubitus group (p < 0.001). No postoperative functional outcomes were reported in the prone positioning group.

Conclusion : Prone positioning in lateral lumbar interbody fusion provides greater postoperative segmental and global lumbar lordosis than lateral decubitus positioning. However, it shows longer surgery times and more intraoperative blood loss. Further data on postoperative outcomes is required to ascertain the superior technique between the two.