Prone Transpsoas Technique for Simultaneous Single-Position Access to the Anterior and Posterior Lumbar Spine

Abstract

BACKGROUND Effective decompression, arthrodesis, and correction of spinal conditions frequently utilize operative approaches that expose both the anterior and posterior spinal column. Until now, circumferential spinal column access often requires the surgeon to reposition and drape the patient multiple times or utilize a posterior only approach that has limited anterior correction capability or to utilize a lateral-only approach that complicates otherwise traditional posterior surgical maneuvers. OBJECTIVE To describe a technique utilizing a single surgical position that enables minimally disruptive anterior column correction with simultaneous access to the posterior spinal column. METHODS The operative technique for accessing the lateral lumbar interbody space from a prone transpsoas (PTP) approach is described. The rationale for this approach and a representative case example are reviewed. RESULTS The PTP approach was used to perform an L3-4 and L4-5 interbody fusion in a 71-yr-old female with spondylolisthesis, severe stenosis, and locked facets. The PTP approach enabled efficient completion of an anterior column correction, direct posterior decompression, multi-segment pedicle fixation, and maintenance of alignment, all while in a single prone position. There were no intraoperative or postoperative complications. CONCLUSION The authors’ early experience with the described PTP technique suggests it is not only feasible but offers some advantages, as it allows for single-position surgery maximizing both anterior and posterior column access and corrective techniques. Further follow-up studies of this technique are ongoing.

Initial multi-centre clinical experience with prone transpsoas lateral interbody fusion: Feasibility, perioperative outcomes, and lessons learned

“…The surgical technique, illustrated by Pimenta et al [12], is consistent with prior LIF descriptions, apart from prone positioning on a Jackson frame-type bed using a procedure-specific positioner and retractor that optimize exposure and efficiency while the patient is in the prone position. The technique as described in Pimenta et al continued to evolve with early clinical experience toward the iterative PTP Initial Multi-center Clinical Experience development of improved procedural systems and steps, as it became clear that simply using the systems historically developed for lateral decubitus LIF would not suffice.…”

“…A technique for approaching the lumbar spine laterally with the patient in the prone position was developed and has been recently described [12] , theorizing that the benefits of lateral anterior column access may be achievable with the patient prone. Such single-position surgery may enable further benefits including intraoperative time savings without repositioning, simultaneous access to the lateral and posterior approaches, and utilization of widely available surgical suite equipment.…”

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

“…The prone transpsoas, or PTP, technique is a relatively new technique wherein transpsoas access to the lumbar disc space and posterior decompression or instrumentation are entirely performed in the prone position, avoiding some of the aforementioned limitations associated with lateral-then-prone or single position LLIF. 14 Initial results of the PTP technique have demonstrated improved clinical and radiographic outcomes. [15][16][17][18] In addition to the possible advantage of avoiding an intraoperative position change, proponents of the PTP technique have cited potential additional benefits such as improved intradiscal lordosis, facilitation of navigation setup, and more secure patient positioning when compared to traditional lateral decubitus LLIF.…”

Prone-transpsoas as single-position, circumferential access to the lumbar spine: A brief survey of index cases

“…PTP uniquely harnesses these strengths in parallel, thus synergizing the releases, gravity, and lumbar cage implantation to grant greater correction of lumbar lordosis than could be achieved otherwise. While an in depth overview of PTP technique and merits are published elsewhere this paper offers our early experiences of PTP, suggesting substantial possibilities for lordotic correction, akin to if not greater than those reported for other open approaches to the lumbar spine [ 1 , 2 ]. ( Fig.…”

“…A detailed discussion of the PTP approach as been published elsewhere [1] . The patient is positioned prone on a standard Jackson table.…”