Prone Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spine Disease: Case Series With an Operative Video Using Fluoroscopy-Based Instrument Tracking Guidance

Abstract

BACKGROUND:Lateral lumbar interbody fusion has inherent limitations, such as the necessity to reposition the patient. To overcome this limitation, the prone transpsoas (PTP) approach for lateral lumbar interbody fusion has been developed.OBJECTIVE:To report clinical and radiographic outcome measures of a series of patients who underwent PTP at our hospital.METHODS:A retrospective chart review was conducted to identify patients who underwent PTP for degenerative lumbar spine disease between September 2019 and August 2021. A thorough analysis of clinical and radiographic outcome measures for these patients was conducted.RESULTS:Our search resulted in the identification of 15 consecutive patients. Four patients were operated using the assistance of fluoroscopy-based instrument tracking. Overall, the mean follow-up duration was 11.9 ± 7.9 months. Radiographically, the PTP approach resulted in significant postoperative improvement of lumbar lordosis (P = .03) and pelvic incidence minus lumbar lordosis (P < .005). No significant difference was found postoperatively in other regional sagittal alignment parameters, including pelvic tilt, sacral slope, or pelvic incidence. Clinically, the patients' Oswestry Disability Indices (P = .002) and Short Form Survey-12 Physical Scores improved significantly (P = .01). The estimated mean blood loss for patients who underwent the PTP procedure was 137.7 ± 96.4 mL, the mean operative time was 212.5 ± 77.1 minutes, and the mean hospital stay was 2.7 ± 1.4 days. One patient each had superficial wound infection, transient paralytic ileus, transient pulmonary embolism, transient urinary retention, or required revision lumbar surgery.CONCLUSION:This study demonstrates that the PTP approach is associated with significant improvement in radiographic and clinical outcomes.

Advancing Prone-Transpsoas Spine Surgery: A Narrative Review and Evolution of Indications with Representative Cases

“…The discectomy and placement of interbody graft are then completed with tracking assistance. This technique has previously been described by Soliman et al [22].…”

Complications of the Prone Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spine Disease: A Multicenter Study

“…11,12 There is limited published literature on the prone transpsoas (PTP) approach to LLIF with most of the studies involving a single surgeon, single center, and small sample. [11][12][13][14][15][16] In this study, we aimed to report the complications of the largest series of patients to date who underwent PTP at multiple centers.…”

“…The procedure was then completed as previously reported. 11,16 In brief, under lateral fluoroscopy guidance, the skin incision was marked, followed by preparing and draping the posterior lumbar region and flank in the usual sterile fashion. This was followed by raising the operating table to the surgeon's eye level, and the flank incision was made.…”

Commentary: Novel Use of Bilateral Prone Transpsoas Approach for the Treatment of Transforaminal Interbody Fusion Pseudarthrosis and Interbody Cage Subsidence

“…Moreover, it facilitates a single-position surgery for the placement of posterior pedicle screws, reducing surgical time. 7-9…”