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

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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.

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Authors and Affiliations

  1. Department of Neurological Surgery, Division of Spine, Duke University, Box 3087, Durham, NC, USA

    Timothy Y. Wang, Vikram A. Mehta, Eric W. Sankey, Christopher I. Shaffrey, Khoi D. Than & Muhammad M. Abd-El-Barr

  2. Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA

    William R. Taylor & Luiz Pimenta

  3. Department of Neurological Surgery, State University of New York at Buffalo, Williamsville, NY, USA

    John Pollina

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  1. Timothy Y. Wang
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  2. Vikram A. Mehta
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  3. Eric W. Sankey
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  9. Muhammad M. Abd-El-Barr
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Corresponding author

Correspondence to Timothy Y. Wang.

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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.

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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

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

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