Lisa Tamburini, MD: No financial relationships to disclose
Introduction: Lumbar interbody fusion is an effective treatment option for mechanical back pain and radicular symptoms from degenerative disease. Interbody fusion through the transpsoas approach can be performed with the patient lateral (LTP) or prone (PTP). We compared outcomes after multilevel LTP or PTP.
Methods: A retrospective chart review of patients undergoing ≥ 3 level LTP or PTP between April 1, 2018 and June 21, 2024 was conducted. Charts were reviewed for demographic, surgical, radiographic, and complication data.
Results: 46 patients were included; 19 (36.8%M, 62.9±10.6 years) in the LTP group and 27 (37%M, 67.1 ± 10.7 years) in the PTP group. No significant difference in comorbidities or surgical characteristics were noted. Average number of levels of interbody fusion were 3.26 ± 0.452 and 3.33 ± 0.48 for the LTP and PTP groups, respectively. Total OR time, surgical time, and length of hospital stay were similar between groups. Significantly more segmental lordosis was obtained in the PTP group (11.7° ± 4.31°) compared to the LTP group (9.52° ± 4.04°) (p=0.002) and this was maintained at one-year follow up (PTP= 11.4° ± 4.57°, LTP= 9.84° ± 3.93°; p=0.082). Posterior disc height was significantly greater initially post-op in the LTP group (9.42 ± 2.55mm) compared to the PTP group (7.68 ± 2.58mm) (p < 0.001). There was a significantly higher incidence of ipsilateral thigh pain in the PTP group (51.9% vs. 21%, p=0.045). A lower incidence of femoral nerve palsy in the PTP group, which approached statistical significance, was also noted (26.3% LTP vs. 7.4% PTP, p=0.070).
Conclusion : LTP and PTP yield comparable outcomes in multi-level lumbar interbody fusion; however, PTP may better restore segmental lumbar lordosis with maintenance at one-year. These results demonstrate that LTP and PTP are safe and effective approaches to treat multi-level lumbar pathology.