Simultaneous Prone Transpsoas Interbody Fusion and Posterior Column Osteotomy, Harnessing Their Advantages for Severe Deformity Correction

Introduction: Prone transpsoas (PTP) surgery is an emerging and adaptable surgical technique that is becoming increasingly popular in modern spine surgery. A key benefit of this access trajectory is the ability to perform simultaneous posterior-column procedures, namely osteotomies. In cases of severe spinal deformity, PTP enhances operative efficiency by facilitating simultaneous anterior and posterior column procedures without requiring patient repositioning.

Methods: A retrospective analysis was conducted on patients who underwent PTP and osteotomy simultaneously. Patient demographics, Oswestry Disability Index (ODI), visual analogue scale (VAS), surgical data, and complications were collected. Additionally, radiologic parameters, including segmental and spinopelvic alignment, were compared between pre- and post-operation at six-weeks.

Results: Four patients met inclusion criteria. The average age of the cohort was 61.3 (±5.8 years) and average BMI was 28.9 kg/m2 (±5.7 kg/m2). Operative time averaged 12.3 hours (±3.6 hours) with an estimated blood loss of 1587.5 mL (±658.0 mL). Average hospital stay was 9.0 days (±4.6 days). Mean preoperative ODI and VAS were 58.0 (±13.4) and 8.0 (±1.2) respectively; ODI improved to 50.7 (±10.4) at six-week follow up [p=0.706] while VAS remained unchanged. Preoperative segmental lordosis of the target the operative level was 4.8-degrees of kyphosis on average and improved to 7.3-degrees of lordosis when examined six-week follow up [p=0.187]. Notably, average global lumbar lordosis improved by 18.5-degrees to 35.3-degrees (± 0.9-degrees) [p=0.030]. All patients had uncomplicated post-operative courses.

Conclusion : Combining PTP with osteotomy is a powerful method for deformity correction without the repositioning required for other MIS deformity correction methods. Additionally, this access trajectory is in the more-familiar prone position. Long term outcomes and more patients will be required to better understand the safety and efficacy of this surgical technique.