Preliminary Clinical and Radiographic Outcomes of the Prone-Angled Transpsoas Approach for Lateral Lumbar Interbody Fusion: A Consecutive Clinical Series.
- 1Department of Neurosurgery, University of California, San Diego, California, USA.
- 2School of Medicine, University of California, San Diego, California, USA.
Abstract
Background and objectives
The prone-angled transpsoas (PAT) approach is a novel lateral lumbar interbody fusion technique that combines the workflow and sagittal alignment advantages of prone positioning with a navigated angled anterior-to-psoas trajectory. Although technical feasibility has been described, clinical outcomes remain limited. This study reports the preliminary clinical, radiographic, and perioperative outcomes of PAT for degenerative lumbar pathology.Methods
A retrospective consecutive cohort study included 35 patients who underwent PAT at a single institution. Clinical outcomes included visual analog scale (VAS) scores for back and leg pain and Oswestry Disability Index. Radiographic outcomes included lumbar lordosis (LL) and segmental lordosis. Perioperative variables and complications were recorded. Preoperative and postoperative outcomes were compared using paired t-tests with available paired observations.Results
Thirty-five patients underwent PAT with placement of 63 interbody cages. The mean age was 68.3 ± 9.4 years, and the mean follow-up was 386.6 days. VAS leg pain decreased from 7.0 ± 2.2 to 1.6 ± 1.4 (n = 31), VAS back pain from 7.2 ± 1.6 to 2.1 ± 1.9 (n = 31), and the Oswestry Disability Index from 63.4 ± 14.8 to 25.8 ± 13.0 (n = 25; all P < .001). LL increased from 29.8° ± 12.4° to 46.2° ± 11.1° (n = 30; mean change, +16.3° ± 7.2°; P < .001). Segmental lordosis increased significantly at L2-3, L3-4, and L4-5, with the greatest increase at L4-5 (+6.8° ± 5.0°; P < .001). Transient iliopsoas pain occurred in 17.1% of patients, and transient quadriceps weakness in 5.7%, with resolution by 6 weeks. Four patients (11.4%) underwent subsequent reoperation. No permanent neurological deficits, vascular injuries, cerebrospinal fluid leaks, or pneumothoraxes occurred.Conclusion
In this preliminary clinical series, PAT was associated with significant improvements in pain, disability, and LL. Transient approach-related symptoms occurred, whereas no permanent neurological or vascular injuries were observed. These early findings support the feasibility of PAT and warrant larger comparative studies to characterize its safety, efficacy, and durability relative to established lateral lumbar interbody fusion approaches.
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BibTeX
@article{kim2026preliminary,
title = {{Preliminary Clinical and Radiographic Outcomes of the Prone-Angled Transpsoas Approach for Lateral Lumbar Interbody Fusion: A Consecutive Clinical Series.}},
author = {Timothy Y Kim and Serajh A S Esmail and William Taylor},
journal = {Neurosurgery practice},
year = {2026},
month = oct,
doi = {10.1227/neuprac.0000000000000317},
url = {https://europepmc.org/article/MED/42910374},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Preliminary Clinical and Radiographic Outcomes of the Prone-Angled Transpsoas Approach for Lateral Lumbar Interbody Fusion: A Consecutive Clinical Series.
AU - Timothy Y Kim
AU - Serajh A S Esmail
AU - William Taylor
PY - 2026
DA - 2026/10/23
JO - Neurosurgery practice
DO - 10.1227/neuprac.0000000000000317
UR - https://europepmc.org/article/MED/42910374
AB - Background and objectives The prone-angled transpsoas (PAT) approach is a novel lateral lumbar interbody fusion technique that combines the workflow and sagittal alignment advantages of prone positioning with a navigated angled anterior-to-psoas trajectory. Although technical feasibility has been described, clinical outcomes remain limited. This study reports the preliminary clinical, radiographic, and perioperative outcomes of PAT for degenerative lumbar pathology.Methods A retrospective consecutive cohort study included 35 patients who underwent PAT at a single institution. Clinical outcomes included visual analog scale (VAS) scores for back and leg pain and Oswestry Disability Index. Radiographic outcomes included lumbar lordosis (LL) and segmental lordosis. Perioperative variables and complications were recorded. Preoperative and postoperative outcomes were compared using paired t-tests with available paired observations.Results Thirty-five patients underwent PAT with placement of 63 interbody cages. The mean age was 68.3 ± 9.4 years, and the mean follow-up was 386.6 days. VAS leg pain decreased from 7.0 ± 2.2 to 1.6 ± 1.4 (n = 31), VAS back pain from 7.2 ± 1.6 to 2.1 ± 1.9 (n = 31), and the Oswestry Disability Index from 63.4 ± 14.8 to 25.8 ± 13.0 (n = 25; all P < .001). LL increased from 29.8° ± 12.4° to 46.2° ± 11.1° (n = 30; mean change, +16.3° ± 7.2°; P < .001). Segmental lordosis increased significantly at L2-3, L3-4, and L4-5, with the greatest increase at L4-5 (+6.8° ± 5.0°; P < .001). Transient iliopsoas pain occurred in 17.1% of patients, and transient quadriceps weakness in 5.7%, with resolution by 6 weeks. Four patients (11.4%) underwent subsequent reoperation. No permanent neurological deficits, vascular injuries, cerebrospinal fluid leaks, or pneumothoraxes occurred.Conclusion In this preliminary clinical series, PAT was associated with significant improvements in pain, disability, and LL. Transient approach-related symptoms occurred, whereas no permanent neurological or vascular injuries were observed. These early findings support the feasibility of PAT and warrant larger comparative studies to characterize its safety, efficacy, and durability relative to established lateral lumbar interbody fusion approaches.
SN - 2834-4383
ER -