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The prone transpsoas technique: preliminary radiographic results of a multicenter experience

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A Correction to this article was published on 19 June 2020

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Abstract

Introduction

The lateral lumbar interbody fusion (LLIF) is a safe and effective technique to treat a vast range of lumbar disorders. However, the technique is also burdened by some problems. A new approach to the lateral lumbar interbody fusion was devised to solve or reduce some of the problems regarding the lateral approach. Its principal difference from the standard LLIF relies on positioning the patient in a prone decubitus, which might lead to an increase in the intradiscal lordosis.

Methods

A retrospective, multicentric, non-randomized study to evaluate segmental and regional lordosis following prone transpsoas (PTP) approach to LLIF. All patients undergoing prone transpsoas surgery at the involved institutions were included. Patients with low-quality images not allowing the measurements of the required spinopelvic parameters were excluded. Measurements included pre- and postoperative index-level segmental lordosis, lumbar lordosis, pelvic incidence, and pelvic tilt.

Results

Thirty-two (32) patients were included in the study, in which 23 underwent single-level, six (6) underwent two-level, Two (2) underwent three-level, and one underwent four-level PTP. Mean index level segmental lordosis increased from 8.7° to 14.8°(p < 0.001); lumbar lordosis (L1-S1) increased from 42.1° to 45.8° (p = 0.11), although after excluding an outlier value L1-S1 lordosis results were 41.9° pre-op to 46.7° post-op (p = 0.003). Twenty-two (22) patients had a pre-op PI-LL mismatch of 10° or more, while at the postoperative visit, only 12 patients had a mismatch outside of 10° (p = 0.01).

Conclusion

The prone transpsoas technique is feasible and is associated with a significant gain of segmental lordosis and correction of spinopelvic alignment parameters.

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Authors and Affiliations

  1. Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil

    Luiz Pimenta, Rodrigo Amaral, Gabriel Pokorny, Raquel Rodrigues, Daniel Arnoni, Thyago Guirelli & Matheus Batista

  2. University of California, UCSD, San Diego, CA, USA

    Luiz Pimenta & William Taylor

  3. Providence Holy Family Hospital, Spokane, WA, USA

    Antoine Tohmeh

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  1. Luiz Pimenta
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Correspondence to Gabriel Pokorny.

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Conflict of interest

Dr. Luiz Pimenta receives consultant fees from Alphatec; Dr. Rodrigo Amaral receives consultant fees from Alphatec, Nuvasive, and Astrolab; Dr. Antoine Tohmeh receives consultancy fee and royalties from Alphatec and has research support from RTI/Zyga and Mainstay Medical; Dr. William Taylor receives consultancy fees and royalties from Alphatec. The other authors have none conflicts to disclose

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Pimenta, L., Amaral, R., Taylor, W. et al. The prone transpsoas technique: preliminary radiographic results of a multicenter experience. Eur Spine J 30, 108–113 (2021). https://doi.org/10.1007/s00586-020-06471-y

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