Development of a decision-making pathway for utilizing standalone lateral lumbar interbody fusion

Purpose To develop a decision-making pathway for primary SA-LLIF. Furthermore, we analyzed the agreement of this pathway and compared outcomes of patients undergoing either SA-LLIF or 360-LLIF. Method A decision-making pathway for SA-LLIF was created based on the results of interviews/surveys of senior spine surgeons with over 10 years of experience. Internal validity was retrospectively evaluated using consecutive patients undergoing either SA-LLIF or 360-LLIF between 01/2018 and 07/2020 with 3D-printed Titanium cages. An outcome assessment looking primarily at revision surgery and secondary at cage subsidence, changes in disk and foraminal height, global and segmental lumbar lordosis, duration of surgery, estimated blood loss, and length of stay was carried out. Results 78 patients with 124 treated levels (37 SA-LLIF, 41 360-LLIF) were retrospectively analyzed. The pathway showed a direct agreement (SA-LLIF) of 100.0% and an indirect agreement (360-LLIF) of 95.1%. Clinical follow-up averaged 13.5 ± 6.5 months including 4 revision surgeries in the 360-LLIF group and none in the SA-LLIF group ( p = 0.117). Radiographic follow-up averaged 9.5 ± 4.3 months, with no statistically significant difference in cage subsidence rate between the groups ( p = 0.440). Compared to preoperative images, patients in both groups showed statistically significant changes in disk height ( p