23 Lateral Lumbar Interbody Fusion

10.1055/b-0039-166432

23 Lateral Lumbar Interbody Fusion

Ankur S. Narain, Fady Y. Hijji, Philip K. Louie, Daniel D. Bohl, and Kern Singh

23.1 Case Presentation

A 55-year-old man presents to the clinic complaining of an 8-month history of gradually worsening low back pain. The patient notes bilateral lower extremity radiculopathy radiating to the anteromedial thigh. He has failed multiple trials of physical therapy and steroidal injections. On physical examination, the patient is noted to exhibit a sensory loss on the right anterior thigh. The patient’s radiographs and magnetic resonance imaging (MRI) findings are shown in Figs. 23.1 and 23.2 . The surgeon schedules the patient for a lateral lumbar interbody fusion (LLIF).

**Fig. 23.1** Anteroposterior **(a)** and lateral **(b)** lumbar radiographs. Significant spondylosis is apparent at the L2–L3 disk level with radial and anterior osteophyte formation. Note the concurrent retrolisthesis of L2 over L3.

**Fig. 23.2** Sagittal **(a)** and axial **(b)** cuts of a T2-weighted lumbar MRI. There is significant degeneration of the L2–L3 disk with moderate bilateral foraminal stenosis.

23.2 Indications

Lumbar nerve root compression above the level of the iliac crest.
Lumbar instability.
Tumors.
Infection or anterior lumbar abscess.

23.3 Positioning

Lateral decubitus position.
Superficial landmarks include:
- Ribs and associated intercostal spaces.
- Pubic symphysis.
- Lateral border of rectus abdominis muscle:
  - 5 cm lateral to midline.
- Spinous processes of desired levels.