Skip to main content

Single-position prone transpsoas fusion for the treatment of lumbar adjacent segment disease: early experience of twenty-four cases across three tertiary medical centers

Abstract

Purpose

Prone transpsoas fusion (PTP) is a minimally invasive technique that maximizes the benefit of lateral access interbody surgery and the prone positioning for surgically significant adjacent segment disease. The authors describe the feasibility, reproducibility and radiographic efficacy of PTP when performed for cases of lumbar ASD.

Methods

Adult patients undergoing PTP for treatment of lumbar ASD at three institutions were retrospectively enrolled. Demographic information was recorded, as was operative data such as adjacent segment levels, operative time, blood loss, laterality of approach, open versus percutaneous pedicle screw instrumentation and need for primary decompression. Radiographic measurements including segmental and global lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope and sagittal vertical axis were recorded both pre- and immediately post-operatively.

Results

Twenty-four patients met criteria for inclusion. Average age was 60.4 ± 10.4 years and average BMI was 31.6 ± 5.0 kg/m2. Total operative time was 204.7 ± 83.3 min with blood loss of 187.9 ± 211 mL. Twenty-one patients had pedicle screw instrumentation exchanged percutaneously and 3 patients had open pedicle screw exchange. Two patients suffered pulmonary embolism that was treated medically with no long-term sequelae. One patient had transient lumbar radicular pain and all patients were discharged home with an average length of stay of 3.0 days (range 1–6). Radiographically, global lumbar lordosis improved by an average of 10.3 ± 9.0 degrees, segmental lordosis by 10.1 ± 13.3 degrees and sagittal vertical axis by 3.2 ± 3.2 cm.

Conclusion

Single-position prone transpsoas lumbar interbody fusion is a clinically reproducible minimally invasive technique that can effectively treat lumbar adjacent segment disease.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Virk SS, Niedermeier S, Yu E, Khan SN (2014) Adjacent segment disease. Orthopedics 37(8):547–555

    PubMed  Article  Google Scholar 

  2. Eichholz KM, Ryken TC (2003) Complications of revision spinal surgery. Neurosurg Focus 15(3):E1

    PubMed  Article  Google Scholar 

  3. Saavedra-Pozo FM, Deusdara RA, Benzel EC (2014) Adjacent segment disease perspective and review of the literature. Ochsner J 14(1):78–83

    PubMed  PubMed Central  Google Scholar 

  4. Formica M, Zanirato A, Cavagnaro L, Basso M, Divano S, Felli L, Formica C (2017) Extreme lateral interbody fusion in spinal revision surgery: clinical results and complications. Eur Spine J 26(Suppl 4):464–470

    PubMed  Article  Google Scholar 

  5. Caputo AM, Michael KW, Chapman TM, Jennings JM, Hubbard EW, Isaacs RE, Brown CR (2013) Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis. J Clin Neurosci 20(11):1558–1563

    PubMed  Article  Google Scholar 

  6. Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM (2010) A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine (Phila Pa 1976) 35(26 Suppl):S322–S330

  7. Liang Z, Cui J, Zhang J, He J, Tang J, Ren H, Ye L, Liang JX (2020) Biomechanical evaluation of strategies for adjacent segment disease after lateral lumbar interbody fusion: is the extension of pedicle screws necessary? BMC Musculoskelet Disord 21(1):117

    PubMed  PubMed Central  Article  Google Scholar 

  8. Yasuda T, Hasegawa T, Yamato Y, Togawa D, Kobayashi S, Yoshida G, Banno T, Arima H, Oe S, Matsuyama Y (2018) Effect of position on lumbar lordosis in patients with adult spinal deformity. J Neurosurg Spine 29(5):530–534

    PubMed  Article  Google Scholar 

  9. Fei H, Li WS, Sun ZR, Jiang S, Chen ZQ (2017) Effect of patient position on the lordosis and scoliosis of patients with degenerative lumbar scoliosis. Medicine (Baltimore) 96(32):e7648

    Article  Google Scholar 

  10. Pimenta L, Amaral R, Taylor W, Tohmeh A, Pokorny G, Rodrigues R, Arnoni D, Guirelli T, Batista M (2021) The prone transpsoas technique: preliminary radiographic results of a multicenter experience. Eur Spine J 30(1):108–113

    PubMed  Article  Google Scholar 

  11. Godzik J, Ohiorhenuan IE, Xu DS, de Andrada PB, Walker CT, Whiting AC, Turner JD, Uribe JS (2020) Single-position prone lateral approach: cadaveric feasibility study and early clinical experience. Neurosurg Focus 49(3):E15

    PubMed  Article  Google Scholar 

  12. Pimenta L, Taylor WR, Stone LE, Wali AR, Santiago-Dieppa DR (2020) Prone transpsoas technique for simultaneous single-position access to the anterior and posterior lumbar spine. Oper Neurosurg (Hagerstown) 20(1):E5–E12

    Article  Google Scholar 

  13. Epstein NE (2015) Adjacent level disease following lumbar spine surgery: a review. Surg Neurol Int 6(Suppl 24):S591-599

    PubMed  PubMed Central  Article  Google Scholar 

  14. Akbarnia BA, Mundis GM Jr, Moazzaz P, Kabirian N, Bagheri R, Eastlack RK, Pawelek JB (2014) Anterior column realignment (ACR) for focal kyphotic spinal deformity using a lateral transpsoas approach and ALL release. J Spinal Disord Tech 27(1):29–39

    PubMed  Article  Google Scholar 

  15. Kudo Y, Okano I, Toyone T, Matsuoka A, Maruyama H, Yamamura R, Ishikawa K, Hayakawa C, Tani S, Sekimizu M et al (2020) Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression. Neurosurg Focus 49(3):E11

    PubMed  Article  Google Scholar 

  16. Louie PK, Varthi AG, Narain AS, Lei V, Bohl DD, Shifflett GD, Phillips FM (2018) Stand-alone lateral lumbar interbody fusion for the treatment of symptomatic adjacent segment degeneration following previous lumbar fusion. Spine J 18(11):2025–2032

    PubMed  Article  Google Scholar 

  17. Yasmeh S, Bernatz J, Garrard E, Bice M, Williams SK (2021) Clinical and radiographic outcomes of lateral interbody fusion for adjacent segment degeneration. Int J Spine Surg 15(1):74–81

    PubMed  PubMed Central  Article  Google Scholar 

  18. Blizzard DJ, Thomas JA (2018) MIS single-position lateral and oblique lateral lumbar interbody fusion and bilateral pedicle screw fixation: feasibility and perioperative results. Spine (Phila Pa 1976) 43(6):440–446

  19. Buckland AJ, Ashayeri K, Leon C, Manning J, Eisen L, Medley M, Protopsaltis TS, Thomas JA (2020) Single position circumferential fusion improves operative efficiency, reduces complications and length of stay compared with traditional circumferential fusion. Spine J

  20. Oda Y, Yamauchi T, Tanaka M (2019) Lateral lumbar interbody fusion with percutaneous pedicle screw in combination with microendoscopic laminectomy in the lateral position for lumbar canal stenosis. Acta Med Okayama 73(4):373–377

    PubMed  Google Scholar 

  21. Guiroy A, Carazzo C, Camino-Willhuber G, Gagliardi M, Fernandes-Joaquim A, Cabrera JP, Menezes C, Asghar J (2021) Single-position surgery versus lateral-then-prone-position circumferential lumbar interbody fusion: a systematic literature review. World Neurosurg.

  22. Lee SK, Lee SH, Song KS, Park BM, Lim SY, Jang G, Lee BS, Moon SH, Lee HM (2016) Lumbar lordosis of spinal stenosis patients during intraoperative prone positioning. Clin Orthop Surg 8(1):65–70

    PubMed  PubMed Central  Article  Google Scholar 

  23. Salem W, Coomans Y, Brismee JM, Klein P, Sobczak S, Dugailly PM (2015) Sagittal thoracic and lumbar spine profiles in upright standing and lying prone positions among healthy subjects: influence of various biometric features. Spine (Phila Pa 1976) 40(15):E900–E908.

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Timothy Y. Wang.

Ethics declarations

Conflict of interest

Timothy Y. Wang, Vikram A. Mehta, Eric W. Sankey: none; Christopher I. Shaffrey: consultant to Biomet, NuVasive, Medtronic, Globus, and SI-BONE; having direct stock ownership in NuVasive; being a patent holder for Medtronic, NuVasive, and Zimmer Biomet; and receiving royalties from Medtronic, NuVasive, and Zimmer Biomet. Khoi D. Than: consultant for Bioventus, Integrity, Globus, Depuy; honorarium from LifeNet. William R. Taylor: consultant for NuVasive, consultant for AlphaTec, consultant for Depuy Synthes. John Pollina: consultant for AlphaTec, teaching and speaker fees and research support from Medtronic, and is on the scientific advisory board with Medtronic. Luiz Pimenta: consultant for AlphaTec. Muhammad M. Abd-El-Barr: consultant for Spineology.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wang, T.Y., Mehta, V.A., Sankey, E.W. et al. Single-position prone transpsoas fusion for the treatment of lumbar adjacent segment disease: early experience of twenty-four cases across three tertiary medical centers. Eur Spine J 31, 2255–2261 (2022). https://doi.org/10.1007/s00586-022-07255-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07255-2

Keywords

  • Prone
  • Lumbar
  • Adjacent segment disease
  • Transpsoas
  • Single position