Background:

Anterior lumbar interbody fusion (ALIF) is commonly performed in patients with degenerative pathology at L4-5 and L5-S1. Exposure of the lumbar spine is appreciated through a retroperitoneal approach. Posterior spine fusion (PSF) is usually performed to supplement the anterior fixation. However, performing an ALIF in the supine position and then performing PSF in the prone position adds significant time due to the flipping of the patient. We present a clinical case in which we performed an ALIF and PSF from a single position. Initial data from our institution demonstrates that this method may save 2-3 hours per case, as the ALIF approach and posterior spine screw placements can be performed simultaneously.

Purpose:

The purpose of this video is to present a clinical scenario in which we detail our single position approach to a combined ALIF and PSF. We review pearls in positioning, surgical technique, use of intraoperative imaging, and postoperative expectations and course.

Methods:

We present a case of a 57-year old female with chronic back and leg pain due to L5-S1 isthmic spondylolisthesis. ALIF and PSF from a single position was performed. We review our indications, positioning, surgical technique, and use of intraoperative imaging. We present her postoperative course, as well as imaging six weeks postoperatively.

Results:

A successful anterior/posterior spinal fusion at L5-S1 was performed in a single position. The patient excelled with physical therapy following surgery, and there were no postoperative complications.

Conclusion:

Combined ALIF and PSF from a single position is a relatively new technique. It provides successful fusion at lumbar intervals, and saves more time, as the anterior approach and placement of posterior screws can be placed simultaneously, without the need to reposition the patient.