Improved outcomes and less OR time—what the data says about lateral SPS

Spinal Tech

X360 single-position surgery (SPS) is a comprehensive approach to lateral single-position surgery enabled by a combination of less invasive procedural solutions—XALIF™, XLIF®, XFixation™. The ability to bring these approaches into an efficient operative workflow while keeping the patient in a single position allows surgeons to craft patient-specific treatment plans for pathologies across the thoracolumbar spine.

X360 SPS clinical summary

The implementation of X360 SPS has the potential to activate a wide variety of efficiencies for surgeons and hospitals, all without compromising the postoperative alignment or clinical goals of surgery.1-6 The current literature surrounding X360 SPS reflects a reduction in OR time, shorter hospital stays, less time under anesthesia for patients, improved efficiencies and workflows in the OR for surgeons, reduction in perioperative costs for the hospital, reduction in postoperative ileus with the utilization of XALIF, and the elimination of complications attributable to intraoperative flips and prone patient positioning.1-11

Highlights of X360 SPS

  • Reduced time under anesthesia.1–3
  • Reduced intraoperative complication risk profile.7–9
  • Reduced length of hospital stay by more than 50%.1,2
  • Reduced OR time up to 200 minutes.1
  • Reduced hospital costs by an average of $80 per minute and up to $16,000 per patient.1,10,11

NuVasive believes the support of strong clinical validation is vital to advancing care for patients and continues to support further research in this area. To assess the perioperative safety and efficacy of single-position AP lumbar fusion surgery, a multicenter study was completed with a large, 390-patient cohort to show the clinical efficacy of X360 SPS.1 The study demonstrated improvements in operative time, estimated blood loss, length of stay, fluoroscopy radiation dosage and the rate of postoperative ileus complications, while maintaining safety compared to more traditional flip-based surgery.

A true, comprehensive approach to lateral single-position surgery

From preoperative patient positioning to postoperative measurement of an intended surgical outcome, X360 SPS is a complete procedural solution. Technologies, inclusive of the NuVasive Advanced Materials Science®, Cohere® XLIF, Modulus® XLIF, Pulse—as well as the integrated platform of Pulse, further support the advanced offering X360 SPS has.


In an L2-S1 case, X360 SPS enabled the surgeon to perform an XLIF at L2–L5, an XALIF at L5–S1, and bilateral percutaneous pedicle screw placement in the lateral position (XFixation) at L2–S1. The entire surgery was optimized by the NuVasive Pulse platform to assist with alignment planning, intraoperative neuromonitoring, navigation, imaging enhancement, radiation reduction, and patient-specific rod bending.



Learn more about X360 SPS at


1. Buckland A, Ashayeri K, Leon C, et al. Single position circumferential fusion improves operative efficiency, reduces complications and length of stay compared with traditional circumferential fusion. Spine J 2021 May;21(5):810-20.

2. Ashayeri K, Leon C, Tigchelaar S, Fatemi P, et al. Single position lateral decubitus Anterior Lumbar Interbody Fusion (ALIF) and posterior fusion reduces complications and improves perioperative outcomes compared with traditional anterior-posterior lumbar fusion. Spine J 2021 Sep 30:S1529-9430(21)00925-6. Epub ahead of print.

3. Mills E, Treloar J, Idowu O, et al. Single position lumbar fusion: a systematic review and meta-analysis. Spine J 2021 Oct 23;S1529-9430(21)00972-4. Epub ahead of print.

4. Thomas J, Thomason, C, Braly B, Menezes C. Rate of failure of indirect decompression in lateral single-position surgery: clinical results. Neurosurg Focus 2020 Sep;49(3):E5.

5. Thomas JA. Single-position lateral lumbar interbody fusion and percutaneous pedicle screw fixation allows for adequate correction of spinal sagittal imbalance. Paper presented at Society for Minimally Invasive Spine Surgery (SMISS) 2016 Annual Forum. Las Vegas, NV, USA.

6. Bodon G, Degreif J. Fluoroscopy-based percutaneous posterior screw placement in the lateral position using the tunnel view technique: technical note. Eur Spine J 2022 Feb 3. doi: 10.1007/s00586-022-07126-w. Epub ahead of print.

7. Anderton JM. The prone position for the surgical patient: a historical review of the principles and hazards. Br J Anaesth 1991;67(4):452-63.14.

8. Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth 2008;100(2):165-83.15.

9. DePasse JM, Palumbo MA, Haque M, et al. Complications associated with prone positioning in elective spinal surgery. World J Orthop 2015;6(3):351-9.

10. Macario A. What does one minute of operating room time cost? J Clin Anesth 2010;22(4):233-6.

11. Shippert RD. A study of time-dependent operating room fees and how to save $100,000 by using time-saving products. Am J Cosmet Surg 2005;22(1):25-34.

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