Beyond the learning curve, advanced applications of prone lateral lumbar interbody fusion

Prone lateral lumbar interbody fusion (pLLIF) extends the traditional lateral approach by allowing simultaneous anterior and posterior access without intraoperative repositioning. While its safety and efficiency during the initial learning curve have been described, its utility beyond this phase remains underexplored. This case series illustrates advanced applications of pLLIF in four distinct pathologies: (1) L4–5 access with high iliac crest anatomy requiring angled retractor docking; (2) anterior column realignment (ACR) with a hyperlordotic cage and Smith-Petersen osteotomy for sagittal realignment; (3) a hybrid deformity correction with L2–3 pLLIF and S1 pedicle subtraction osteotomy (PSO) to address high pelvic incidence; and (4) a single-position thoracic corpectomy with posterior spinal fusion for T8 burst fracture using a retropleural approach. Across diverse pathologies, pLLIF enabled streamlined single-position correction strategies, efficient operative workflows, and favorable clinical and radiographic outcomes. Beyond the initial learning curve, it functions as a versatile, minimally invasive platform for addressing both focal and complex spinal pathology.