Neurosurgery practice · 2026
Preliminary Clinical and Radiographic Outcomes of the Prone-Angled Transpsoas Approach for Lateral Lumbar Interbody Fusion: A Consecutive Clinical Series.
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Kim Timothy Y, Esmail Serajh A S, Taylor William
Аннотация
BACKGROUND AND OBJECTIVES: The prone-angled transpsoas (PAT) approach is a novel lateral lumbar interbody fusion technique that combines the workflow and sagittal alignment advantages of prone positioning with a navigated angled anterior-to-psoas trajectory. Although technical feasibility has been described, clinical outcomes remain limited. This study reports the preliminary clinical, radiographic, and perioperative outcomes of PAT for degenerative lumbar pathology.
METHODS: A retrospective consecutive cohort study included 35 patients who underwent PAT at a single institution. Clinical outcomes included visual analog scale (VAS) scores for back and leg pain and Oswestry Disability Index. Radiographic outcomes included lumbar lordosis (LL) and segmental lordosis. Perioperative variables and complications were recorded. Preoperative and postoperative outcomes were compared using paired t-tests with available paired observations.
RESULTS: Thirty-five patients underwent PAT with placement of 63 interbody cages. The mean age was 68.3 ± 9.4 years, and the mean follow-up was 386.6 days. VAS leg pain decreased from 7.0 ± 2.2 to 1.6 ± 1.4 (n = 31), VAS back pain from 7.2 ± 1.6 to 2.1 ± 1.9 (n = 31), and the Oswestry Disability Index from 63.4 ± 14.8 to 25.8 ± 13.0 (n = 25; all P < .001). LL increased from 29.8° ± 12.4° to 46.2° ± 11.1° (n = 30; mean change, +16.3° ± 7.2°; P < .001). Segmental lordosis increased significantly at L2-3, L3-4, and L4-5, with the greatest increase at L4-5 (+6.8° ± 5.0°; P < .001). Transient iliopsoas pain occurred in 17.1% of patients, and transient quadriceps weakness in 5.7%, with resolution by 6 weeks. Four patients (11.4%) underwent subsequent reoperation. No permanent neurological deficits, vascular injuries, cerebrospinal fluid leaks, or pneumothoraxes occurred.
CONCLUSION: In this preliminary clinical series, PAT was associated with significant improvements in pain, disability, and LL. Transient approach-related symptoms occurred, whereas no permanent neurological or vascular injuries were observed. These early findings support the feasibility of PAT and warrant larger comparative studies to characterize its safety, efficacy, and durability relative to established lateral lumbar interbody fusion approaches.
METHODS: A retrospective consecutive cohort study included 35 patients who underwent PAT at a single institution. Clinical outcomes included visual analog scale (VAS) scores for back and leg pain and Oswestry Disability Index. Radiographic outcomes included lumbar lordosis (LL) and segmental lordosis. Perioperative variables and complications were recorded. Preoperative and postoperative outcomes were compared using paired t-tests with available paired observations.
RESULTS: Thirty-five patients underwent PAT with placement of 63 interbody cages. The mean age was 68.3 ± 9.4 years, and the mean follow-up was 386.6 days. VAS leg pain decreased from 7.0 ± 2.2 to 1.6 ± 1.4 (n = 31), VAS back pain from 7.2 ± 1.6 to 2.1 ± 1.9 (n = 31), and the Oswestry Disability Index from 63.4 ± 14.8 to 25.8 ± 13.0 (n = 25; all P < .001). LL increased from 29.8° ± 12.4° to 46.2° ± 11.1° (n = 30; mean change, +16.3° ± 7.2°; P < .001). Segmental lordosis increased significantly at L2-3, L3-4, and L4-5, with the greatest increase at L4-5 (+6.8° ± 5.0°; P < .001). Transient iliopsoas pain occurred in 17.1% of patients, and transient quadriceps weakness in 5.7%, with resolution by 6 weeks. Four patients (11.4%) underwent subsequent reoperation. No permanent neurological deficits, vascular injuries, cerebrospinal fluid leaks, or pneumothoraxes occurred.
CONCLUSION: In this preliminary clinical series, PAT was associated with significant improvements in pain, disability, and LL. Transient approach-related symptoms occurred, whereas no permanent neurological or vascular injuries were observed. These early findings support the feasibility of PAT and warrant larger comparative studies to characterize its safety, efficacy, and durability relative to established lateral lumbar interbody fusion approaches.