Versatility of the Prone Lateral Approach and How it Affects Preoperative Decision Making

Versatility of the Prone Lateral Approach and How it Affects Preoperative Decision Making.

I present a case of an Octogenarian patient with osteopenia and a grade 2 L4-5 mobile spondylolisthesis. Over the course of 4-years the patient’s symptoms continued to progress prompting desire for surgical intervention. With a BMI of >40, the collaborating ALIF access surgeon was not excited about the anterior approach at L4-5.

A narrow small TLIF interbody has a higher probability of subsidence. Looking at the axial images on the pre-op MRI, the anteriorly located PSOAS suggests an anterior lumbar plexus thus the inability to safely execute the lateral interbody technique.

I strongly desired a large interbody for height restoration, biomechanical stability and spondy reduction purposes so I elected to attempt the #proneXLIF (plan A), knowing I could quickly and safely convert to a TLIF (plan B) if the passage, as assessed using neuromonitoring, was unsafe.

Post operative CT demonstrating a well placed interbody. Post operative MRI demonstrating improvement of lateral recess / subarticular stenosis.

Please let me know how this preoperative MRI influences your decision making on the treatment strategy for this patient.

#spinesurgery #spinefusion #neurosurgery