Who is a candidate?
Prone lateral interbody fusion is considered when a collapsed disc space and spinal alignment both need addressing, degenerative scoliosis, flatback with loss of the normal lumbar curve, spondylolisthesis, or stenosis where restoring disc height contributes to relieving the nerves. It requires a safe lateral corridor to the disc, which is assessed on imaging beforehand, and it is generally not used at the lowest lumbar level where the pelvis blocks access.
How the procedure works
You are positioned face down for the entire operation. Through a small incision in the side, the surgeon passes between the muscle layers of the flank to reach the side of the disc, guided by continuous nerve monitoring. The disc is removed and a large spacer is placed to restore height and correct alignment. Posterior decompression and screw fixation are then performed through separate small incisions without repositioning you.
Recovery
Walking begins the day of surgery. Numbness or weakness in the front of the thigh on the approach side is not unusual early on, from traversing the muscle that crosses that corridor, and it typically improves over weeks. Hospital stay depends on the number of levels. Bending and lifting are restricted while the fusion consolidates over several months.
Benefits and alternatives
Doing everything in one position avoids the time and imprecision of turning a patient mid-operation, and the prone posture aids alignment correction. The large spacer restores disc height, which can indirectly decompress the nerves. Alternatives include MIS TLIF, ALIF, traditional lateral fusion in the side-lying position, open correction for larger deformities, and continued non-operative care.
Risks
Risks include infection, bleeding, injury to the nerves crossing the lateral corridor, thigh numbness or weakness, bowel or vascular injury, hardware problems, and failure of the bone to fuse. Nerve monitoring is used throughout to reduce, though not eliminate, the risk to the nerves in the approach path.