Prone transpsoas (PTP)-LLIF approach versus standard LLIF in patients undergoing surgical revision following adult spinal deformity correction surgery

Luis D. Diaz-Aguilar, Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA. Electronic address: Ddiazag1@health.ucsd.edu.
Nolan J. Brown, Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA.
Andrew Nguyen, Department of Neurological Surgery, University of California-Irvine, Orange, CA, USA.
Saarang Patel, Department of Biological Sciences, Seton Hall University, South Orange, NJ, USA.
Zach Pennington, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Lauren E. Stone, Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA.
Nicholas S. Hernandez, Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA.
Julian Gendreau, Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA.
Mohamed Soliman, Department of Neurological Surgery, Jacobs College of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Asham Khan, Department of Neurological Surgery, Jacobs College of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Alexander Padovano, Department of Orthopedic Surgery, Washington University School of Medicine in St Louis, St Louis, MO, USA; Department of Orthopaedic Surgery, WakeMed, Raleigh, NC, USA.
Jeff Ehresman, Barrow Neurological Institute, Department of Neurological Surgery, Phoenix, AZ, USA.
John Pollina, Department of Neurological Surgery, Jacobs College of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Rodrigo Amaral, Department of Neurological Surgery, Instituto de Patologia da Coluna, São Palo Sul, Brazil.
Muhammad M. Abd-El-Barr, Department of Neurological Surgery, Duke University Medical Center, Durham, NC, USA.
Isaac Moss, Department of Orthopedic Surgery, University of Connecticut, Farmington, CT, USA.
Tyler G. Smith, Sierra Spine Institute, Roseville, CA, USA.
Gurvinder Deol, Wake Orthopaedics, WakeMed Health and Hospitals, Raleigh, NC, USA.
Bryan S. Lee, Barrow Neurological Institute, Department of Neurological Surgery, Phoenix, AZ, USA.
M Craig McMains, OrthoIndy, Indianapolis, IN, USA.
Samuel Joseph, Joseph Spine Institute, Tampa, FL, USA.
David Schwartz, OrthoIndy, Indianapolis, IN, USA.
Luiz Pimenta, Department of Neurological Surgery, Instituto de Patologia da Coluna, São Palo Sul, Brazil.
Christopher Dibble, Department of Neurosurgery, Atrium Health Wake Forest Baptist, Wake Forest, NC, USA.
Martin H. Pham, Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA.
Andrew D. Nguyen, Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA.
William Taylor, Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA.

Document Type

Article

Abstract

INTRODUCTION: Both the prone transpsoas (PTP) single-position lateral lumbar interbody fusion (LLIF) and standard (dual-position) LLIF enable minimally invasive (MIS) indirect decompression and deformity correction. Existing studies comparing the utility of these approaches for adult spinal deformity (ASD) correction have been limited to small, single-center series. No study has investigated revision single-position PTP-LLIF versus standard LLIF in a large cohort of ASD patients. METHODS: A multi-center cohort of all patients undergoing PTP-LLIF or standard LLIF revision for ASD between 2013 and 2021 were identified from 12 spine surgery centers. Standing 36″ scoliosis radiographs were retrospectively reviewed for assessment of spinopelvic parameters including pelvic incidence (PI), lumbar lordosis (LL), and PI-LL mismatch preoperatively and immediately postoperative. Multivariable analysis was performed to assess the primary outcome measure: postoperative change in regional sagittal alignment (PI-LL mismatch) between patients who had undergone revision surgery via PTP versus standard LLIF. Postoperative PI-LL mismatch correction was defined by PI-LL mismatch <10°. RESULTS: Two-hundred and two patients were retrospectively identified and included for formal analysis. One-hundred and fifty-one (n = 151, 74.8 %) patients underwent PTP revision while 51 (25.2 %) underwent standard LLIF revision. Patients undergoing PTP had greater pre-operative PI-LL mismatch (21.4 vs. 10.45°; p < 0.001). Complication rate (p = 0.029), length of stay (<0.001) and total follow up (p = 0.005) were decreased in the PTP patients when compared to standard LLIF, while fluoroscopy time (p = 0.036) and fluoroscopy dosage (p = 0.011) was increased. Multivariate analysis demonstrated that PTP was associated with increased change of having a postoperative PI-LL value <10° (p < 0.001), in addition to being associated with increased correction of PI-LL mismatch (p = 0.002) when controlling for multiple other variables. CONCLUSION: Ultimately, PTP-LLIF was associated with greater net improvement in postoperative PI-LL mismatch, the primary outcome measure of this study. The present retrospective analysis expands upon previous studies demonstrating the potential superiority of PTP-LLIF versus conventional LLIF for sagittal plane correction in ASD revision surgery.

Medical Subject Headings

Humans; Spinal Fusion (methods); Male; Female; Reoperation (methods); Middle Aged; Retrospective Studies; Lumbar Vertebrae (surgery); Aged; Psoas Muscles (surgery); Prone Position; Adult; Scoliosis (surgery); Treatment Outcome

Publication Date

11-1-2025

Publication Title

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

E-ISSN

1532-2653

Volume

141

First Page

111558

PubMed ID

40812249

Digital Object Identifier (DOI)

10.1016/j.jocn.2025.111558

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