Pub Date : 2025-06-01DOI: 10.1016/j.semss.2025.101177
Alfred-John Bayaton , Michael R. McDermott , Hannah Grimmett , Mihir Chadra , Ashish Patel
This five-year retrospective study examined operative efficiency in 107 single-level L4–5 prone lateral lumbar interbody fusion (pLLIF) cases within a 324-patient series. Operative time declined 70 %, from 161 min in 2019 to 48 min in 2024, with progressive narrowing of interquartile ranges. No femoral nerve injuries occurred in the single-level cohort, and complications were infrequent, limited to the early learning phase. Contributing factors included improved fluoroscopic coordination, retractor control, and team cohesion. These findings may provide surgeons adopting the technique an idea of the efficiency gains that can be expected with growing experience.
{"title":"From adoption to optimization: A 5-year analysis of efficiency in single-position prone lateral lumbar interbody fusion at L4–5","authors":"Alfred-John Bayaton , Michael R. McDermott , Hannah Grimmett , Mihir Chadra , Ashish Patel","doi":"10.1016/j.semss.2025.101177","DOIUrl":"10.1016/j.semss.2025.101177","url":null,"abstract":"<div><div>This five-year retrospective study examined operative efficiency in 107 single-level L4–5 prone lateral lumbar interbody fusion (pLLIF) cases within a 324-patient series. Operative time declined 70 %, from 161 min in 2019 to 48 min in 2024, with progressive narrowing of interquartile ranges. No femoral nerve injuries occurred in the single-level cohort, and complications were infrequent, limited to the early learning phase. Contributing factors included improved fluoroscopic coordination, retractor control, and team cohesion. These findings may provide surgeons adopting the technique an idea of the efficiency gains that can be expected with growing experience.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 2","pages":"Article 101177"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.semss.2025.101180
Bryan J. Heard, Scott Mallozzi, Michael H Weber, Isaac L. Moss, Hardeep Singh
Prone transpsoas lateral lumbar interbody fusion (LLIF) is an emerging minimally invasive technique, that combines the advantages of lateral access with the efficiency of a single-position approach. This approach enhances segmental and global alignment correction with large-footprint lordotic interbody devicess, facilitates spondylolisthesis reduction, and can reduce operative and anesthetic time. However, prone transpsoas LLIF presents unique challenges, necessitating meticulous preoperative planning and intraoperative execution. Neurological complications, primarily transient radiculopathy or sensory symptoms, occur in approximately 8.2% of cases, with most resolving within three months. Notably, hip flexor weakness and pain - likely secondary to psoas muscle dissection and retraction - are most common, but typically resolved within several months. Preoperative planning focuses on optimal patient selection, considering key anatomical factors such as iliac crest height, vasculature location, and psoas anatomy to minimize complications. Intraoperative risk mitigation relies on precise patient positioning, strategic incision planning, and careful retroperitoneal dissection guided via real-time fluoroscopy and neuromonitoring. Effective postoperative management necessitates vigilant monitoring, proactive pain management, and early mobilization. With proper technique and patient selection, prone transpsoas LLIF offers improved surgical efficiency, favorable clinical outcomes, and low complication rates, reinforcing its utility in minimally invasive spine surgery.
{"title":"Complication avoidance in prone single-position lateral spine surgery: Strategies and best practice","authors":"Bryan J. Heard, Scott Mallozzi, Michael H Weber, Isaac L. Moss, Hardeep Singh","doi":"10.1016/j.semss.2025.101180","DOIUrl":"10.1016/j.semss.2025.101180","url":null,"abstract":"<div><div>Prone transpsoas lateral lumbar interbody fusion (LLIF) is an emerging minimally invasive technique, that combines the advantages of lateral access with the efficiency of a single-position approach. This approach enhances segmental and global alignment correction with large-footprint lordotic interbody devicess, facilitates spondylolisthesis reduction, and can reduce operative and anesthetic time. However, prone transpsoas LLIF presents unique challenges, necessitating meticulous preoperative planning and intraoperative execution. Neurological complications, primarily transient radiculopathy or sensory symptoms, occur in approximately 8.2% of cases, with most resolving within three months. Notably, hip flexor weakness and pain - likely secondary to psoas muscle dissection and retraction - are most common, but typically resolved within several months. Preoperative planning focuses on optimal patient selection, considering key anatomical factors such as iliac crest height, vasculature location, and psoas anatomy to minimize complications. Intraoperative risk mitigation relies on precise patient positioning, strategic incision planning, and careful retroperitoneal dissection guided via real-time fluoroscopy and neuromonitoring. Effective postoperative management necessitates vigilant monitoring, proactive pain management, and early mobilization. With proper technique and patient selection, prone transpsoas LLIF offers improved surgical efficiency, favorable clinical outcomes, and low complication rates, reinforcing its utility in minimally invasive spine surgery.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 2","pages":"Article 101180"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.semss.2025.101192
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 Y Park , Yu-Po Lee , Sohaib Hashmi
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.
{"title":"Prone lateral lumbar corpectomy: Surgical technique and case series outcomes","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 Y Park , Yu-Po Lee , Sohaib Hashmi","doi":"10.1016/j.semss.2025.101192","DOIUrl":"10.1016/j.semss.2025.101192","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Material and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 2","pages":"Article 101192"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.semss.2025.101178
Michael R. McDermott , Alfred-John Bayaton , Dane Wheeler , Ashish Patel
Lateral lumbar interbody fusion (LLIF) places the femoral nerve at risk, particularly at L4–5. Traditional neuromonitoring modalities often fail to detect acute, segmental injuries in real time. Transabdominal Muscle Action Potential (TMAP) stimulates the conus medullaris and records lower extremity myotomal responses, offering motor feedback resistant to anesthetic suppression. In our series, TMAP showed 100 % sensitivity for detecting femoral nerve injury. A structured, event-based TMAP protocol improved intraoperative awareness and specificity. When paired with t-EMG, TMAP anchors a multimodal strategy that enables precise, real-time neuromonitoring and may redefine safety standards for LLIF by capturing injury at the moment it occurs.
{"title":"Advanced neuromonitoring in lateral surgery – The role of transabdominal muscle action potential","authors":"Michael R. McDermott , Alfred-John Bayaton , Dane Wheeler , Ashish Patel","doi":"10.1016/j.semss.2025.101178","DOIUrl":"10.1016/j.semss.2025.101178","url":null,"abstract":"<div><div>Lateral lumbar interbody fusion (LLIF) places the femoral nerve at risk, particularly at L4–5. Traditional neuromonitoring modalities often fail to detect acute, segmental injuries in real time. Transabdominal Muscle Action Potential (TMAP) stimulates the conus medullaris and records lower extremity myotomal responses, offering motor feedback resistant to anesthetic suppression. In our series, TMAP showed 100 % sensitivity for detecting femoral nerve injury. A structured, event-based TMAP protocol improved intraoperative awareness and specificity. When paired with t-EMG, TMAP anchors a multimodal strategy that enables precise, real-time neuromonitoring and may redefine safety standards for LLIF by capturing injury at the moment it occurs.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 2","pages":"Article 101178"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 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
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.
{"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":"10.1016/j.semss.2025.101191","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":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.semss.2025.101181
Zachary NaPier
Prone Transpsoas Lateral Interbody Fusion (PTP LIF) represents a natural evolution of lateral decubitus LIF by producing enhanced lordosis associated with the familiar prone position. Techniques such as anterior docking, anterior column realignment (ACR), screws first spondylolisthesis reduction, and anterior placement of large, expandable cages allow the surgeon to maximize sagittal correction when appropriate. Caution must be taken not to create too much lordosis in upper lumbar levels, especially in patients with low pelvic incidence. As sagittal alignment targets have evolved from global to regional and now segmental, the versatility of PTP LIF will allow surgeons to achieve level specific reconstructions with more precision and less invasiveness for the betterment of patient outcomes.
{"title":"Sagittal plane optimization with prone transpsoas lateral interbody fusion (PTP LIF)","authors":"Zachary NaPier","doi":"10.1016/j.semss.2025.101181","DOIUrl":"10.1016/j.semss.2025.101181","url":null,"abstract":"<div><div>Prone Transpsoas Lateral Interbody Fusion (PTP LIF) represents a natural evolution of lateral decubitus LIF by producing enhanced lordosis associated with the familiar prone position. Techniques such as anterior docking, anterior column realignment (ACR), screws first spondylolisthesis reduction, and anterior placement of large, expandable cages allow the surgeon to maximize sagittal correction when appropriate. Caution must be taken not to create too much lordosis in upper lumbar levels, especially in patients with low pelvic incidence. As sagittal alignment targets have evolved from global to regional and now segmental, the versatility of PTP LIF will allow surgeons to achieve level specific reconstructions with more precision and less invasiveness for the betterment of patient outcomes.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 2","pages":"Article 101181"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.semss.2025.101179
Ashish Patel , Alfred-John Bayaton , Daniel Misioura , Michael R. McDermott
Prone lateral lumbar interbody fusion (pLLIF) extends the traditional lateral approach by allowing simultaneous anterior and posterior access without intraoperative repositioning. While its safety and efficiency during the initial learning curve have been described, its utility beyond this phase remains underexplored. This case series illustrates advanced applications of pLLIF in four distinct pathologies: (1) L4–5 access with high iliac crest anatomy requiring angled retractor docking; (2) anterior column realignment (ACR) with a hyperlordotic cage and Smith-Petersen osteotomy for sagittal realignment; (3) a hybrid deformity correction with L2–3 pLLIF and S1 pedicle subtraction osteotomy (PSO) to address high pelvic incidence; and (4) a single-position thoracic corpectomy with posterior spinal fusion for T8 burst fracture using a retropleural approach. Across diverse pathologies, pLLIF enabled streamlined single-position correction strategies, efficient operative workflows, and favorable clinical and radiographic outcomes. Beyond the initial learning curve, it functions as a versatile, minimally invasive platform for addressing both focal and complex spinal pathology.
{"title":"Beyond the learning curve, advanced applications of prone lateral lumbar interbody fusion","authors":"Ashish Patel , Alfred-John Bayaton , Daniel Misioura , Michael R. McDermott","doi":"10.1016/j.semss.2025.101179","DOIUrl":"10.1016/j.semss.2025.101179","url":null,"abstract":"<div><div>Prone lateral lumbar interbody fusion (pLLIF) extends the traditional lateral approach by allowing simultaneous anterior and posterior access without intraoperative repositioning. While its safety and efficiency during the initial learning curve have been described, its utility beyond this phase remains underexplored. This case series illustrates advanced applications of pLLIF in four distinct pathologies: (1) L4–5 access with high iliac crest anatomy requiring angled retractor docking; (2) anterior column realignment (ACR) with a hyperlordotic cage and Smith-Petersen osteotomy for sagittal realignment; (3) a hybrid deformity correction with L2–3 pLLIF and S1 pedicle subtraction osteotomy (PSO) to address high pelvic incidence; and (4) a single-position thoracic corpectomy with posterior spinal fusion for T8 burst fracture using a retropleural approach. Across diverse pathologies, pLLIF enabled streamlined single-position correction strategies, efficient operative workflows, and favorable clinical and radiographic outcomes. Beyond the initial learning curve, it functions as a versatile, minimally invasive platform for addressing both focal and complex spinal pathology.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 2","pages":"Article 101179"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.semss.2025.101160
Elyette Lugo, Wesley Durand, Amit Jain
Lumbar interbody fusion is a surgical procedure that fuses two or more vertebrae used to treat degenerative spinal conditions, instability, and deformities. There are several approaches commonly used, such as anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), and lateral lumbar interbody fusion (LLIF), each with distinct risks and limitations. Anterior-to-the psoas oblique lateral interbody fusion (ATP/OLIF) is a surgical approach that was introduced to optimize lumbar interbody fusion while mitigating risks associated with the traditional approaches. ATP/OLIF utilizes an oblique surgical corridor between the psoas muscle and major vascular structures. ATP/OLIF offers a minimally invasive alternative for lumbar fusion, providing safe access to the L1-L5 levels, particularly L4-L5, with reduced risk of vascular injury (compared to ALIF) and lumbar plexus irritation (compared to PLIF). This chapter outlines the rationale, indications, surgical approach, and technical pearls essential for successful ATP/OLIF implementation. Compared to ALIF, TLIF, and LLIF, ATP/OLIF minimizes the need for vascular mobilization and neural retraction, improving surgical efficiency and patient outcomes.
{"title":"Oblique lateral interbody fusion: Technique and pearls","authors":"Elyette Lugo, Wesley Durand, Amit Jain","doi":"10.1016/j.semss.2025.101160","DOIUrl":"10.1016/j.semss.2025.101160","url":null,"abstract":"<div><div>Lumbar interbody fusion is a surgical procedure that fuses two or more vertebrae used to treat degenerative spinal conditions, instability, and deformities. There are several approaches commonly used, such as anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), and lateral lumbar interbody fusion (LLIF), each with distinct risks and limitations. Anterior-to-the psoas oblique lateral interbody fusion (ATP/OLIF) is a surgical approach that was introduced to optimize lumbar interbody fusion while mitigating risks associated with the traditional approaches. ATP/OLIF utilizes an oblique surgical corridor between the psoas muscle and major vascular structures. ATP/OLIF offers a minimally invasive alternative for lumbar fusion, providing safe access to the L1-L5 levels, particularly L4-L5, with reduced risk of vascular injury (compared to ALIF) and lumbar plexus irritation (compared to PLIF). This chapter outlines the rationale, indications, surgical approach, and technical pearls essential for successful ATP/OLIF implementation. Compared to ALIF, TLIF, and LLIF, ATP/OLIF minimizes the need for vascular mobilization and neural retraction, improving surgical efficiency and patient outcomes.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101160"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.semss.2025.101162
Prashanth J Rao , Nipun Shreshtha , Gayani Petersingham , Andrew J Berg , Kevin Seex
Background
Degenerative disc and facet joint disease are prevalent conditions in the aging population, often leading to disability. Oblique lumbar interbody fusion (OLIF) /anterior to psoas (ATP) surgeries provide effective treatment by stabilizing the affected segment, offering indirect decompression of neural elements, and correcting coronal and sagittal deformities. Other indications include instability, infection, tumour and revision surgery. This review aims to assess the anatomical and technical considerations essential for performing OLIF/ATP surgeries between L2-L5 .
Methods
The surgical techniques and anatomical and technical considerations for lumbar interbody fusion using OLIF/ATP at the L2/3, L3/4, and L4/5 levels were examined.
Results
This review outlines anatomical and technical considerations for a successful ATP/OLIF procedure L2-L5.
Conclusion
This study thoroughly reviews the literature on OLIF/ATP and provides recommendations and guidelines on anatomical and technical considerations for ATP/OLIF procedures at L2/3, L3/4 and L4/5.
{"title":"L2/3, L3/4 and L4/5 oblique lumbar interbody fusion/anterior to psoas: Anatomical and technical considerations","authors":"Prashanth J Rao , Nipun Shreshtha , Gayani Petersingham , Andrew J Berg , Kevin Seex","doi":"10.1016/j.semss.2025.101162","DOIUrl":"10.1016/j.semss.2025.101162","url":null,"abstract":"<div><h3>Background</h3><div>Degenerative disc and facet joint disease are prevalent conditions in the aging population, often leading to disability. Oblique lumbar interbody fusion (OLIF) /anterior to psoas (ATP) surgeries provide effective treatment by stabilizing the affected segment, offering indirect decompression of neural elements, and correcting coronal and sagittal deformities. Other indications include instability, infection, tumour and revision surgery. This review aims to assess the anatomical and technical considerations essential for performing OLIF/ATP surgeries between L2-L5 .</div></div><div><h3>Methods</h3><div>The surgical techniques and anatomical and technical considerations for lumbar interbody fusion using OLIF/ATP at the L2/3, L3/4, and L4/5 levels were examined.</div></div><div><h3>Results</h3><div>This review outlines anatomical and technical considerations for a successful ATP/OLIF procedure L2-L5.</div></div><div><h3>Conclusion</h3><div>This study thoroughly reviews the literature on OLIF/ATP and provides recommendations and guidelines on anatomical and technical considerations for ATP/OLIF procedures at L2/3, L3/4 and L4/5.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101162"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OLIF is a variant of anterolateral approach to lumbar spine that aims to mitigate shortcomings of other anterior approaches. It utilizes surgical corridor termed oblique corridor that's located between great vessels and psoas muscle. In this review we aim to explore technical aspects of anterior to psoas approach and associated issues and dangers. Possible complications and prevention strategies will be discussed as well as different techniques and surgical tips. New developments in surgical technique and approach variations will be showcased
{"title":"Anterior-to-psoas OLIF: Surgical approach, issues & technical nuances","authors":"Stjepan Ivandić , Jure Pavešić , Stipe Ćorluka , Tomislav Čengić","doi":"10.1016/j.semss.2025.101159","DOIUrl":"10.1016/j.semss.2025.101159","url":null,"abstract":"<div><div>OLIF is a variant of anterolateral approach to lumbar spine that aims to mitigate shortcomings of other anterior approaches. It utilizes surgical corridor termed oblique corridor that's located between great vessels and psoas muscle. In this review we aim to explore technical aspects of anterior to psoas approach and associated issues and dangers. Possible complications and prevention strategies will be discussed as well as different techniques and surgical tips. New developments in surgical technique and approach variations will be showcased</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"37 1","pages":"Article 101159"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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