Prone vs. lateral positioning for lateral lumbar interbody fusion: a narrative review of clinical outcomes and complications

Lateral lumbar interbody fusion (LLIF) is a minimally invasive approach for degenerative lumbar spine pathology that restores disc height and achieves indirect decompression using large-footprint interbody cages. Traditionally, LLIF has been performed in the lateral decubitus position with repositioning for posterior instrumentation [dual-position lateral decubitus LLIF (ldLLIF)]. Contemporary workflows now include single-position ldLLIF and prone LLIF (pLLIF). The objective of this narrative review is to compare ldLLIF and pLLIF while explicitly accounting for dual- versus single-position workflows and to clarify the relative contributions of positioning and workflow to reported operative and clinical differences.