Simultaneous Anterior and Posterior Approach for Prone Lateral Lumbar Interbody Fusion With Robotically Assisted Posterior Instrumentation: 2-Dimensional Operative Video.

Lateral lumbar interbody fusion (LLIF) in the prone position is a minimally invasive technique for treating degenerative lumbar diseases by achieving arthrodesis and lumbar lordosis through the anterior column. Achieving circumferential fusion after LLIF can be challenging and requires screw placement in the lateral position or prone repositioning. Previous studies have described a single-position lateral transpsoas interbody fusion in the prone position as an alternative technique, which may allow for increased segmental lordosis and increased surgeon comfortability with posterior instrumentation. We build on this single-position surgery and present a simultaneous anterior and posterior approach for prone LLIF, which allows the patient to remain in the prone position while 2 operative windows into the spine are created. This enables one surgeon to place pedicle screws in the posterior spinal column while the other surgeon simultaneously performs LLIF in the anterior spinal column through a transpsoas approach. This approach is further enhanced with intraoperative navigation, which ensures trajectories are maintained during prone lateral disk space access and pedicle screw insertion. In this case, the total operative time was 166 minutes, and the estimated blood loss was 200 mL. The participants and any identifiable individuals consented to publication of their image; the patient consented to the procedure.Simultaneously, obtaining lateral access and inserting posterior instrumentation preclude patient repositioning and can further shorten operative time compared with previously described single-position surgeries, reducing the risk of intraoperative complications. Still, prone positioning remains challenging in patients with significant adiposity or difficult anatomy (eg, high iliac crest).