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Single-Position Lateral Lumbar Interbody Fusion in Prone: Single-Centric Case-Series

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Abstract

The main difference between prone and lateral surgery is that the patient’s position is changed from lateral decubitus to prone, which may work around the three principal difficulties of the standard lateral approach. The prone transpsoas (PTP) technique enables single-position surgery with more familiar patient positioning, which improves lumbar lordosis and lengthens the psoas muscle, pushing it posteriorly. Therefore, this study aimed to examine the clinical and surgical outcomes of the prone transpsoas procedure. This was a retrospective case series in which patients with up to two levels of lateral lumbar interbody fusion in the prone decubitus position for degenerative diseases were included. The outcomes of interest were classified as surgical or clinical. According to the variable distribution, Kruskal–Wallis or one-way ANOVA was used to assess variance across all groups, and the t-test or Wilcoxon test was used to examine intragroup variances. The statistical significance level was set at p < 0.05. Thirty-nine patients participated in the trial. The average operating time was 166 min (± 79 min), and the average blood loss was 182 mL (± 151 mL). The median length of hospital stay was 1 day, with an interquartile range of 1.25 days. All clinical outcomes significantly improved at 1–3, 6–12, and 24–36 months compared to baseline. There was one intraoperative (2.5%) and two post-operative complications (5.1%). According to the authors’ case experience, PTP is a safe, practical, and reproducible procedure capable of treating a wide spectrum of degenerative disorders.

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Abbreviations

ALIF :

Anterior lumbar interbody fusion

EBL :

Estimated blood loss

EQ5D3L :

Euroqol-5D-3L

ICU :

Intensive care unit

IQR :

Interquartile range

LLIF :

Lateral lumbar interbody fusion

LOS :

Length of stay

NRS :

Numeric rating scale

ODI :

Oswestry Disability Index

PTP :

Prone transpsoas technique

SD :

Standard deviation

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Authors and Affiliations

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

    Rodrigo Amaral, Jack Miles, Gabriel Pokorny, Fernando Marcelino, Rafael Moriguchi, Igor Barreira, Jullyene Pokorny, Weby Mizael & Luiz Pimenta

Authors
  1. Rodrigo Amaral
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  2. Jack Miles
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  3. Gabriel Pokorny
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  4. Fernando Marcelino
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  7. Jullyene Pokorny
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  8. Weby Mizael
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  9. Luiz Pimenta
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Contributions

RA and LP: conceptualization, investigation, and writing of the original draft. JM: writing — original draft, visualization, and conceptualization. GP: conceptualization, methodology, formal analysis, writing — review and editing, project administration, and supervision. RM: data collection. IB: data collection. JP: manuscript revision and project administration. WM: data collection. FM: data collection.

Corresponding author

Correspondence to Gabriel Pokorny.

Ethics declarations

Ethics Approval

The study was approved by the Ethics Committee under the following CAAE: 35144920.4.0000.8054—Hospital Moriah—Rede Moriah Saúde Ltda.

Consent to Participate

All the patients signed a free-consent form prior to being included in the study.

Written Consent for Publication

NA

Conflict of Interest

Dr. Luiz Pimenta and Dr. Rodrigo Amaral received consultancy fee from ATEC. Dr. Jack Miles is related to a high-rank employee from ATEC.

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Rodrigo Amaral is the first author.

Level of Evidence: III

This article is part of the Topical Collection on Surgery

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Amaral, R., Miles, J., Pokorny, G. et al. Single-Position Lateral Lumbar Interbody Fusion in Prone: Single-Centric Case-Series. SN Compr. Clin. Med. 5, 260 (2023). https://doi.org/10.1007/s42399-023-01604-y

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