Simultaneous Oblique Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation Combined With Endoscopic-Assisted Decompression in the Lateral Position for Two-Level Lumbar Pathology

Hybrid minimally invasive spine surgery (MISS) is evolving with the integration of navigation and endoscopic techniques. We describe a fluoroscopy-free hybrid MIS procedure for pathology at two different spinal levels. A 71-year-old female with recurrent low back and left leg pain following prior multilevel decompression underwent oblique lumbar interbody fusion (OLIF) with simultaneous percutaneous pedicle screw (PPS) fixation and lateral endoscopic-assisted decompression at separate levels without repositioning and without intraoperative fluoroscopy. The operative time was 163 minutes, with 200 mL of estimated blood loss (EBL) and no intraoperative complications. Postoperative imaging confirmed accurate screw placement with adequate neural decompression, both direct and indirect. The Oswestry Disability Index (ODI) improved from 49% to 20% at the one-year follow-up. This technical note demonstrates the feasibility of a simultaneous two-surgeon workflow for OLIF, with drift-prevention steps and endoscopic-assisted decompression in the same position, to reduce radiation exposure, blood loss, and operative time while providing efficient and safe treatment for selected lumbar degenerative cases. This case is particularly important in situations in which the patient requires decompression in the lateral decubitus position, such as during pregnancy or in cases of severe chest or abdominal injury.