Patient-Centered Outcomes Following Prone Lateral Single-Position Approach to Same-Day Circumferential Spine Surgery

Abstract

Study Design. Retrospective study. Objective. Evaluate surgical characteristics and postoperative 2-year results of the PL approach to spinal fusion. Summary of Background Data. Prone-lateral(PL) single positioning has recently gained popularity in spine surgery due to lower blood loss and operative time but has yet to be examined for other notable outcomes, including realignment and patient-reported measures. Materials and Methods. We included circumferential spine fusion patients with a minimum one-year follow-up. Patients were stratified into groups based on undergoing PL approach versus same-day staged (Staged). Mean comparison tests identified differences in baseline parameters. Multivariable logistic regression, controlling for age, levels fused, and Charlson Comorbidity Index were used to determine the influence of the approach on complication rates, radiographic and patient-reported outcomes up to two years. Results. One hundred twenty-two patients were included of which 72(59%) were same-day staged and 50(41%) were PL. PL patients were older with lower body mass index (both P<0.05). Patients undergoing PL procedures had lower estimated blood loss and operative time (both P<0.001), along with fewer osteotomies (63% vs. 91%, P<0.001). This translated to a shorter length of stay (3.8 d vs. 4.9, P=0.041). PL procedures demonstrated better correction in both PT (4.0 vs. −0.2, P=0.033 and pelvic incidence and lumbar lordosis (−3.7 vs. 3.1, P=0.012). PL procedures were more likely to improve in GAP relative pelvic version (OR: 2.3, [1.5–8.8]; P=0.003]. PL patients suffered lesser complications during the perioperative period and greater improvement in NRS-Back (−6.0 vs. −3.3, P=0.031), with less reoperations (0.0% vs. 4.8%, P=0.040) by two years. Conclusions. Patients undergoing PL single-position procedures received less invasive procedures with better correction of pelvic compensation, as well as earlier discharge. The prone lateral cohort also demonstrated greater clinical improvement and a lower rate of reoperations by two years following spinal corrective surgery. Level of Evidence. Level—III