Prone Single-Position Lateral Lumbar Interbody Fusion Surgery

The prone transpsoas (PTP) approach presents an alternative to the traditional lateral lumbar interbody fusion (LLIF), which is typically performed with the patient in the lateral decubitus position. PTP surgery offers several advantages, including enhanced segmental lordosis, the ability to perform the entire procedure in a single position, and improved access for posterior techniques. However, the learning curve for PTP differs from that of conventional LLIF. This chapter outlines the senior author’s approach to PTP surgery, reviewing essential strategies for preoperative evaluation, patient selection, operative techniques, and intraoperative considerations. The goal of this technical guide is to accelerate proficiency for new adopters, optimize surgical workflow, and enhance patient safety. A comprehensive analysis of the PTP technique was conducted, incorporating preoperative imaging, planning strategies, and technical refinements in patient positioning based on the senior author’s expertise. The workflow was structured to facilitate smooth transitions between levels, minimize operative time, and reduce physical strain on the surgical team. By implementing these key strategies for preoperative planning, patient positioning, and intraoperative monitoring, surgeons can maximize procedural benefits, enhance safety, and minimize risk when performing PTP LLIFs.