Stand-alone prone lateral interbody fusion: a retrospective case series.

Abstract

Background: Prone lateral spine surgery has gained traction as a single-position approach due to advantages including reduced operative time, and improved lordosis restoration compared with traditional decubitus lateral approaches. Stand-alone anterior lumbar interbody fusion (ALIF) and direct lateral fusion (DLF) techniques have demonstrated reduced operative time, blood loss, length of stay, and cost compared with posteriorly instrumented constructs, though with higher reported rates of subsidence. While stand-alone instrumentation has been described for ALIF and DLF, its use in the prone lateral transpsoas approach has not previously been reported. This study presents a retrospective case series evaluating the feasibility, perioperative outcomes, and radiographic characteristics of stand-alone prone lateral lumbar interbody fusion.

Case description: Eight adult patients underwent elective, single-level stand-alone prone lateral lumbar interbody fusion performed by a single surgeon at a large academic institution between May 2020 and September 2025. All patients had prior multilevel lumbar fusion and American Society of Anesthesiologists (ASA) classifications of 2 to 3. Static and expandable cages with integrated lateral plating were utilized. Operative time ranged from 80 to 194 minutes (median 112 minutes), estimated blood loss ranged from 5 to 50 mL (median 50 mL), and length of hospital stay ranged from 1 to 3 days (median 2 days). Three of eight patients required revision surgery (37.5%); one experienced postoperative numbness due to inadequate decompression and two required revision due to subsidence. Radiographic analysis demonstrated median increases in anterior disc height (6.54 mm), posterior disc height (2.75 mm), and foraminal height (2.0 mm). Median change in lumbar lordosis on both immediate postoperative and long-term imaging was ten degrees and seven degrees, respectively. Median change in segmental lordosis on immediate and long-term postoperative imaging was ten degrees and five degrees respectively.

Conclusions: This case series of stand-alone prone lateral interbody fusion demonstrates the technical feasibility in select patients. While outcomes pertaining to disc height and lordotic restoration were favorable, surgeons considering this technique should be aware of the complications and revisions observed in this series. Further studies with larger cohorts and longer follow-up are needed to better define the influence of bone quality, indications, radiographic durability, and long-term outcomes of this approach.