Prone lateral lumbar corpectomy: Surgical technique and case series outcomes

Abstract

Introduction

The use of lumbar corpectomy and posterior stabilization has been well described in various pathologies. However, the conventional anterior approach has been associated with numerous postoperative complications, prompting shifts in surgeons toward alternate approaches. Herein, we describe our experience with the single-position, prone, retropleural, and transpsoas corpectomy, which allows for simultaneous anterior and posterior column access in a single stage. We hypothesize that patients who undergo this technique with posterior decompression and stabilization will result in significant improvements in sagittal alignment and a low incidence of postoperative complications compared to traditional anterior approaches.

Material and methods

This retrospective cohort study included 9 adult patients who underwent prone transpsoas corpectomy at UC Irvine from January - December 2023. All patients underwent a single staged, single position prone lateral transpsoas lumbar corpectomy with posterior instrumentation. Clinical data collected included: demographics, surgical data, postoperative outcomes and perioperative complications.

Results

Of the 9 patients, 6 received single-level corpectomy, and 3 received 2-level corpectomy. Average age was 53.8 years. There were 4 pathologic fractures, 3 lumbar burst fractures, and 2 vertebral osteomyelitis with collapse. Total posterior instrumentation was on average 1.89 levels above and below the level(s) of corpectomy. The average preoperative sagittal alignment was 23.5 degrees of kyphosis, while the average postoperative sagittal alignment was 12.3 degrees of lumbar lordosis, with an average change of 35.5 degrees in sagittal alignment. One patient required reoperation in the setting of chronic osteomyelitis infection. No other instances of new neurologic deficits, hardware failure, infection, pseudoarthrosis or adjacent segment disease were observed in the remaining patients.

Conclusion

Prone transpsoas single-position corpectomy is a safe and reliable technique for simultaneous anterior and posterior decompression, instrumentation, and fusion. Our series demonstrated 35.5 degrees of sagittal correction, and restoration of alignment in a safe and efficacious manner.