Lateral decubitus versus prone Transpsoas lateral lumbar interbody fusion: A comparative analysis of perioperative outcomes, complications, and surgical staging

Q4 Medicine

Seminars in Spine Surgery Pub Date : 2025-06-01 DOI:10.1016/j.semss.2025.101191

Ryan Le, Michael S Kim, Sultan Baz, Brandon Lehman, Ryan Hoang, Pirooz Fereydouni, Christopher Lee, Justin Chan, Rafa Oliveira, Emily Mills, Hansen Bow, Michael Oh, Hao-Hua Wu, Nitin Bhatia, Don Park, Yu-Po Lee, Sohaib Z. Hashmi

{"title":"Lateral decubitus versus prone Transpsoas lateral lumbar interbody fusion: A comparative analysis of perioperative outcomes, complications, and surgical staging","authors":"Ryan Le, Michael S Kim, Sultan Baz, Brandon Lehman, Ryan Hoang, Pirooz Fereydouni, Christopher Lee, Justin Chan, Rafa Oliveira, Emily Mills, Hansen Bow, Michael Oh, Hao-Hua Wu, Nitin Bhatia, Don Park, Yu-Po Lee, Sohaib Z. Hashmi","doi":"10.1016/j.semss.2025.101191","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Lateral lumbar interbody fusion may be performed through lateral decubitus (LD-LLIF) or prone transpsoas (PTP) approaches. While PTP offers theoretical advantages related to single-position access and sagittal alignment, comparative data evaluating perioperative outcomes, complication profiles, and radiographic parameters remain limited. This study compares clinical outcomes, complications, and radiographic alignment between LD-LLIF and PTP, with additional subgroup analysis of staged versus single-stage LD-LLIF procedures.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted at a single academic center. Adult patients undergoing LD-LLIF or PTP between August 2021 and March 2024 by fellowship-trained orthopaedic spine surgeons were identified. Demographics, comorbidities, operative parameters, radiographic measurements, and perioperative outcomes were collected. Subgroup analysis compared staged and single-stage LD-LLIF procedures. Statistical analysis utilized two-sided <em>t</em>-tests and chi-squared tests with significance set at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>A total of 82 patients were included (LD-LLIF: 54; PTP: 28). Operative time was significantly longer in PTP compared to LD-LLIF (472.5 ± 204.5 vs. 266.8 ± 91.0 minutes, <em>p</em> < 0.001). PTP was associated with higher estimated blood loss (<em>p</em> = 0.056), shorter hospital stay (<em>p</em> = 0.050), and increased rates of dural tear (14.3% vs. 0%, <em>p</em> = 0.012) and transient postoperative hip flexor weakness (21.4% vs. 0%, <em>p</em> = 0.001). Radiographically, PTP demonstrated greater postoperative segmental lordosis (12.4 ± 4.5° vs. 10.4 ± 4.0°, <em>p</em> = 0.041) and Cobb angle correction (−0.8 ± 5.0° vs. −4.3 ± 5.9°, <em>p</em> = 0.009), with no significant differences in global lumbar or L4-S1 lordosis. In the LD-LLIF subgroup, staged procedures (<em>n</em> = 18) demonstrated longer operative time (292.9 ± 46.6 vs. 231.0 ± 123.7 minutes, <em>p</em> = 0.013), but complication rates were not significantly different compared to single-stage procedures (27.8% vs. 21.1%, <em>p</em> = 0.736).</div></div><div><h3>Conclusion</h3><div>Both LD-LLIF and PTP achieved effective radiographic correction with acceptable complication profiles. LD-LLIF and PTP may be used in the treatment of primary and revision lumbar spinal pathology. In our series, PTP was associated with longer operative time and higher neurologic complication rates. Staged LD-LLIF procedures increased operative duration without increasing complication rates. Further prospective investigation is warranted to optimize patient selection and evaluate long-term outcomes.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 2","pages":"Article 101191"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Seminars in Spine Surgery","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1040738325000358","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Lateral lumbar interbody fusion may be performed through lateral decubitus (LD-LLIF) or prone transpsoas (PTP) approaches. While PTP offers theoretical advantages related to single-position access and sagittal alignment, comparative data evaluating perioperative outcomes, complication profiles, and radiographic parameters remain limited. This study compares clinical outcomes, complications, and radiographic alignment between LD-LLIF and PTP, with additional subgroup analysis of staged versus single-stage LD-LLIF procedures.

Methods

A retrospective observational study was conducted at a single academic center. Adult patients undergoing LD-LLIF or PTP between August 2021 and March 2024 by fellowship-trained orthopaedic spine surgeons were identified. Demographics, comorbidities, operative parameters, radiographic measurements, and perioperative outcomes were collected. Subgroup analysis compared staged and single-stage LD-LLIF procedures. Statistical analysis utilized two-sided t-tests and chi-squared tests with significance set at p < 0.05.

Results

A total of 82 patients were included (LD-LLIF: 54; PTP: 28). Operative time was significantly longer in PTP compared to LD-LLIF (472.5 ± 204.5 vs. 266.8 ± 91.0 minutes, p < 0.001). PTP was associated with higher estimated blood loss (p = 0.056), shorter hospital stay (p = 0.050), and increased rates of dural tear (14.3% vs. 0%, p = 0.012) and transient postoperative hip flexor weakness (21.4% vs. 0%, p = 0.001). Radiographically, PTP demonstrated greater postoperative segmental lordosis (12.4 ± 4.5° vs. 10.4 ± 4.0°, p = 0.041) and Cobb angle correction (−0.8 ± 5.0° vs. −4.3 ± 5.9°, p = 0.009), with no significant differences in global lumbar or L4-S1 lordosis. In the LD-LLIF subgroup, staged procedures (n = 18) demonstrated longer operative time (292.9 ± 46.6 vs. 231.0 ± 123.7 minutes, p = 0.013), but complication rates were not significantly different compared to single-stage procedures (27.8% vs. 21.1%, p = 0.736).

Conclusion

Both LD-LLIF and PTP achieved effective radiographic correction with acceptable complication profiles. LD-LLIF and PTP may be used in the treatment of primary and revision lumbar spinal pathology. In our series, PTP was associated with longer operative time and higher neurologic complication rates. Staged LD-LLIF procedures increased operative duration without increasing complication rates. Further prospective investigation is warranted to optimize patient selection and evaluate long-term outcomes.

查看原文本刊更多论文

侧卧与俯卧经腰肌外侧腰椎体间融合：围手术期结果、并发症和手术分期的比较分析

背景：侧位腰椎椎体间融合术可通过侧卧（ld - lliff）或俯卧转腰肌（PTP）入路进行。虽然PTP提供了与单位入路和矢状面对齐相关的理论优势，但评估围手术期结果、并发症概况和放射学参数的比较数据仍然有限。本研究比较了LD-LLIF和PTP的临床结果、并发症和影像学检查，并对分期和单期LD-LLIF手术进行了亚组分析。方法在单一学术中心进行回顾性观察性研究。在2021年8月至2024年3月期间，由研究员培训的骨科脊柱外科医生接受LD-LLIF或PTP的成年患者被确定。统计数据、合并症、手术参数、影像学测量和围手术期结果。亚组分析比较了分期和单阶段LD-LLIF手术。统计分析采用双侧t检验和卡方检验，显著性集为p <；0.05.结果共纳入82例患者(LD-LLIF: 54例；元:28)。PTP组的手术时间明显长于LD-LLIF组（472.5±204.5 vs 266.8±91.0分钟），p <；0.001)。PTP与较高的估计失血量（p = 0.056）、较短的住院时间（p = 0.050）、增加的硬脑膜撕裂率（14.3%比0%，p = 0.012）和术后一过性髋关节屈肌无力（21.4%比0%，p = 0.001）相关。放射学上，PTP表现出更大的术后节段性前凸（12.4±4.5°vs 10.4±4.0°，p = 0.041）和Cobb角矫正（- 0.8±5.0°vs - 4.3±5.9°，p = 0.009），整体腰椎或L4-S1前凸无显著差异。在LD-LLIF亚组中，分阶段手术（n = 18）的手术时间更长（292.9±46.6分钟比231.0±123.7分钟，p = 0.013），但并发症发生率与单阶段手术相比无显著差异（27.8%比21.1%,p = 0.736）。结论LD-LLIF和PTP均能获得有效的影像学矫正，并发症可接受。LD-LLIF和PTP可用于治疗原发性和翻修性腰椎病理。在我们的研究中，PTP与较长的手术时间和较高的神经并发症发生率相关。分期LD-LLIF手术增加了手术时间，但未增加并发症发生率。进一步的前瞻性研究是必要的，以优化患者选择和评估长期结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Seminars in Spine Surgery Medicine-Surgery

CiteScore

0.50

自引率

0.00%

发文量

审稿时长

2 days

期刊介绍： Seminars in Spine Surgery is a continuing source of current, clinical information for practicing surgeons. Under the direction of a specially selected guest editor, each issue addresses a single topic in the management and care of patients. Topics covered in each issue include basic anatomy, pathophysiology, clinical presentation, management options and follow-up of the condition under consideration. The journal also features "Spinescope," a special section providing summaries of articles from other journals that are of relevance to the understanding of ongoing research related to the treatment of spinal disorders.