Early Clinical Outcomes of the Prone Transpsoas Lumbar Interbody Fusion Technique

Abstract

Background: The prone transpsoas (PTP) approach for lateral lumbar interbody fusion (LLIF) is a relatively novel technique. Currently, little is known about its associated complications and early patient-reported outcomes. The aim of this study was to investigate the effect of LLIF performed via the PTP approach on sagittal radiographic parameters, patient-reported outcome measures (PROMs), and rates of complications.

Methods: A retrospective review was performed of 82 consecutive patients who underwent LLIF via a PTP technique. Lumbar lordosis (LL), segmental lordosis (SL), anterior disc height (ADH), and posterior disc height (PDH) were measured on preoperative, initial postoperative, and 3-month postoperative radiographs. PROMs including the Oswestry Disability Index (ODI); the visual analog scale (VAS); and pain portions of the EQ5D, VAS back, and VAS leg ratings were collected at the preoperative and subsequent postoperative visits. Length of hospital stay and postoperative complications related to the procedure were recorded.

Results: Significant improvements were seen at the initial (4.5° ± 8.6°, P < 0.001) and 3-month (4.4° ± 7.2°, P < 0.001) postoperative periods for LL, as well as SL (6.8° ± 4.8°, P < 0.001; 6.7° ± 4.4°, P < 0.001), ADH (8.0 mm ± 3.6, P < 0.001; 7.4 mm ± 3.6, P < 0.001), and PDH (3.3 mm ± 2.4, P < 0.001; 3.1 mm ± 2.5, P < 0.001). Significant improvements were seen at 3 months postoperatively for ODI (P < 0.001), EQ5D pain (P = 0.016), VAS leg (P < 0.001), and VAS back (P < 0.001). The average length of stay was 2.7 ± 4.5 days. The most common complications were ipsilateral thigh pain/numbness (45.1%), ipsilateral hip flexor weakness (39.0%), and contralateral thigh pain/numbness (14.6%).

Conclusions: While early PROMs and correction of sagittal radiographic parameters show promising results for the PTP approach for LLIF, it is not without risks.

Clinical relevance: PTP interbody fusion is an emerging technique that allows for simultaneous access to the anterior and posterior columns of the lumbar spine. This early case series demonstrates significant improvement in functional outcomes and lumbar lordosis with a safety profile comparable to other well-established techniques.

Keywords: complications; lateral; lumbar; outcomes; prone; psoas.

Figure 1

Intraoperative images depicting standard prone patient positioning. Pads placed below the axillae and around the hip induce a convex bend in the patient’s abdomen, opening up the near side of the disc space.

Figure 2

Illustration of sagittal radiographic parameters collected.

Figure 3

Function global rating of change (GROC) scores at 2 wk, 6 wk, and 3 mo from surgery.

Figure 4

Pain global rating of change (GROC) scores at 2 wk, 6 wk, and 3 mo from surgery.

Figure 5

Patient acceptable symptom state (PASS) scores at 2 wk, 6 wk, and 3 mo from surgery.