Establishment of the prone transpsoas fusion surgery in Australia-a survey and analysis of major complications in early adopters.

Abstract

Background: Prone transpsoas (PTP) fusion is a single-position variant of direct transpsoas interbody reconstruction that is increasing in popularity in Australia. This technique provides simultaneous access to the anterior and posterior columns while maintaining the familiar prone position and utilising position-specific equipment. However, major vascular, visceral, and neurological complications associated with the procedure remain a concern for spine surgeons. Our study aims to elucidate the safety profile of PTP fusion among early adopters in Australia.

Methods: Australian surgeons interested in the PTP approach underwent surgical education and training prior to their first PTP procedure. All PTP-trained surgeons were invited to participate in the study through an online survey of 14 questions querying their PTP experience. Of the 20 PTP-trained surgeons, 16 responded to the survey, representing 293 out of 327 PTP surgeries completed in Australia from March 2023 to May 2024.

Results: The survey was completed by 16 surgeons (80%) from the Australian PTP community, encompassing 293 PTP surgeries (90%) completed. The surgeon cohort reported no major vascular or visceral complications. There are two cases (0.68%) of weakness of the psoas muscle, two cases (0.68%) of sustained motor deficits, and four cases (1.37%) of sensory deficits. Additionally, there are two cases (0.68%) of vertebral fractures or implant subsidence requiring re-operation and four cases (1.37%) of surgical site infections.

Conclusions: Our study shows the successful establishment of PTP procedure following a PTP surgical training model. The survey's high response rate reinforces the low complication rates encountered by our surgeons and adds to the safety profile of this novel procedure. Additionally, it underscores the significance of surgical education and training opportunities in minimally invasive spinal fusion techniques.