Aug. 25, 2022

Mayo Clinic is one of the few centers in the United States that routinely performs single position spinal reconstructive surgery. The cutting-edge approach typically allows for shorter operating times and hospital stays compared with conventional lumbar interbody fusion (LIF).

"Single position spinal reconstruction has inherent benefits," says Maziyar A. Kalani, M.D., a neurosurgeon at Mayo Clinic in Phoenix/Scottsdale, Arizona. "Blood loss, operating times and hospital stays are dramatically less. We're finding that the outcomes in terms of symptom improvement are equivalent to typical spinal surgeries."

The single position approach avoids moving patients for pedicle screw placement after interbody graft placement. The entire surgery is completed with patients in the lateral decubitus or prone position.

Mayo Clinic performs single position anterior LIF and lateral LIF (LLIF) for individuals with tumors, spinal abnormalities and degenerative spinal conditions.

"This is a tech-heavy procedure. Imaging is 100% crucial," Dr. Kalani says. "Our very strong intraoperative navigation system makes us well suited to provide this kind of surgery."

Optimizing outcomes and reducing costs

Single position spinal reconstruction offers potential cost and technical benefits.

"We can do a single position L3-L4 lateral interbody fusion with posterior instrumentation in less time than if we did an L3-L4 transforaminal LIF (TLIF)," Dr. Kalani says. "The single position gives us better segmental lordosis with a large footprint interbody. That increases the fusion and indirect decompression rates. And patients are going home the next day, compared with a multiday hospital stay with a TLIF."

The new approach can also lower the risk of surgical complications.

"Single position LLIF or extreme LIF allows us to achieve much better disk height without worries of the cage being too small and subsiding into the bone," Dr. Kalani says. "Kyphosis also is less likely."

As a major center for spinal reconstruction, Mayo Clinic can meet the challenges of embracing new surgical techniques. "We're fortunate to have staff with a lot of experience caring for patients who have lateral interbody surgery," Dr. Kalani says. "In-service training and simulations with the new approach build on that experience."

Single position spinal reconstruction isn't suitable for certain individuals. Dr. Kalani cites technical issues involved with patients who have high-riding iliac crests or anterior-riding psoas muscles. Visualization can be difficult when selected individuals are in the prone position for spinal surgery.

"The larger the patient, the more challenging this becomes," Dr. Kalani says. "But image guidance makes that a lot easier." He notes that Mayo Clinic avoids elective spinal operations for individuals with a body mass index above 40.

"Being at the forefront of centers that perform single position spinal reconstruction is very helpful for our patients," Dr. Kalani says.

For more information

Refer a patient to Mayo Clinic.