Prone Transpsoas (PTP) is a single-position, minimally invasive fusion technique. This approach has been implemented for various clinical pathologies, from degenerative disc disease to stabilisation and realignment of the spine. However, the L4/5 level has unique anatomical challenges between the height of the iliac crest, lumbar plexus anatomy, and the right common iliac vein, for the lateral approach. This study evaluates the safety, efficacy, and radiological outcomes of a single-level PTP fusion at the L4/5 level.
A multi-centre, multi-surgeon cohort study involved 100 consecutive patients who underwent single-level PTP fusion at L4/5. All patients provided informed written consent. Data were collected on patient demographics, procedural metrics, clinical, and radiological outcomes, and analyzed using descriptive statistics.
The cohort comprised 100 patients (58 females, 42 males; mean age 69 years, mean BMI 28). The average anesthetic time was 165 minutes, with a total operative time of 112. The lateral operative time for anterior column fusion was 39 minutes, and psoas retraction averaged 15 minutes (±6.3). Radiological outcomes revealed significant increase in lumbar lordosis (pre-operative: 49°±13°, post-operative: 54°±13°, P = 0.02), segmental lordosis (from 10°±5° to 15°±5°, P < 0.001), anterior disc height (from 7.7mm±2.8) to 12.2mm±2.0, P < 0.001), and posterior disc height (from 4.5mm±1.8 to 6.4mm±2.0, P < 0.001). The average cage placement was at the mid-vertebral body in the dorsoventral plane. Post-operative complications include two residual psoas weakness, one psoas hematoma, one periprosthetic infection, one superficial wound infection, and one anterior longitudinal ligament release.
The prone transpsoas approach is a safe and effective method for addressing pathologies at the L4/5 level, demonstrating significant improvements in radiological outcomes. The clinical complications observed here contribute to the safety profile of the PTP fusion technique. Further long-term follow-up is needed to evaluate fusion rates and potential delayed complications.
Presenting Author (First Author):
Dr. Vijidha Shree Rajkumar
Sc. (Hon), M. Sc., MD
E-mail: vijidha@ospine.com.au
Co-Authors:
Professor Brian Owler
Neurosurgeon
MB BS BSc (Med)(Hons) GradCertFin PhD FRACS FAMA
Dr. Yi Yuen Wang
Neurosurgeon
MBBS, FRACS, MD
Abstract Topic Categories
Minimally Invasive Spinal Fusion, Prone Lateral techniques