Radiographic alignment outcomes after the single-position prone transpsoas approach: a multi-institutional retrospective review of 363 cases

Abstract

OBJECTIVE The aim of this paper was to evaluate the changes in radiographic spinopelvic parameters in a large cohort of patients undergoing the prone transpsoas approach to the lumbar spine. METHODS A multicenter retrospective observational cohort study was performed for all patients who underwent lateral lumber interbody fusion via the single-position prone transpsoas (PTP) approach. Spinopelvic parameters from preoperative and first upright postoperative radiographs were collected, including lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT). Functional indices (visual analog scale score), and patient-reported outcomes (Oswestry Disability Index) were also recorded from pre- and postoperative appointments. RESULTS Of the 363 patients who successfully underwent the procedure, LL after fusion was 50.0° compared with 45.6° preoperatively (p < 0.001). The pelvic incidence–lumbar lordosis mismatch (PI-LL) was 10.5° preoperatively versus 2.9° postoperatively (p < 0.001). PT did not significantly change (0.2° ± 10.7°, p > 0.05). CONCLUSIONS The PTP approach allows significant gain in lordotic augmentation, which was associated with good functional results at follow-up.

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

“…12,19 Previous studies have shown that the PTP approach has significant improvement in operative efficiency and sagittal alignment compared with standard LLIF. 12,20 However, none of these studies focused on the clinical outcomes of the PTP approach in a large patient sample.…”

Letter to the Editor. Does the prone transpsoas approach affect LLIF outcomes?

“…Neurosurg Focus. 2023;54 [1]:E3) is interesting and significant to us. In the authors' study, the lateral lumbar interbody fusion (LLIF) procedure was performed via the prone transpsoas (PTP) approach in 363 cases.…”

“…TO THE EDITOR: The article by Diaz-Aguilar et al 1 (Diaz-Aguilar L, Stone LE, Soliman MAR, et al Radiographic alignment outcomes after the single-position prone transpsoas approach: a multi-institutional retrospective review of 363 cases. Neurosurg Focus.…”

“…We were unable to find literature evidence of this occurring in the lumbar spine, although there are papers describing a similar phenomenon of narrowing in the cervical central canal. 1,2 Nonetheless, the PTP approach alleviates this concern by allowing direct decompression posteriorly at any stage of the case and harnessing the anteroposterior movement of the retractors to choose a more posterior cage position. Both of these maneuvers open-rather than stenose-the central canal (Fig.…”

Prone Transpsoas Lateral Interbody Fusion (PTP LIF) with Anterior Docking: Preliminary functional and radiographic outcomes

“…Initial case series of prone LIF have demonstrated safety and efficacy with potentially shorter surgical times and improved segmental lordosis [18 , [25] , [26] , [27] , [28] , [29] , [30] . Patel et al.…”