Advancing Prone-Transpsoas Spine Surgery: A Narrative Review and Evolution of Indications with Representative Cases.


The Prone Transpsoas (PTP) approach to lumbar spine surgery, emerging as an evolution of lateral lumbar interbody fusion (LLIF), offers significant advantages over traditional methods. PTP has demonstrated increased lumbar lordosis gains compared to LLIF, owing to the natural increase in lordosis afforded by prone positioning. Additionally, the prone position offers anatomical advantages, with shifts in the psoas muscle and lumbar plexus, reducing the likelihood of postoperative femoral plexopathy and moving critical peritoneal contents away from the approach. Furthermore, operative efficiency is a notable benefit of PTP. By eliminating the need for intraoperative position changes, PTP reduces surgical time, which in turn decreases the risk of complications and operative costs. Finally, its versatility extends to various lumbar pathologies, including degeneration, adjacent segment disease, and deformities. The growing body of evidence indicates that PTP is at least as safe as traditional approaches, with a potentially better complication profile. In this narrative review, we review the historical evolution of lateral interbody fusion, culminating in the prone transpsoas approach. We also describe several adjuncts of PTP, including robotics and radiation-reduction methods. Finally, we illustrate the versatility of PTP and its uses, ranging from 'simple' degenerative cases to complex deformity surgeries.





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Publication Info

Drossopoulos, Peter N, Anas Bardeesi, Timothy Y Wang, Chuan-Ching Huang, Favour C Ononogbu-Uche, Khoi D Than, Clifford Crutcher, Gabriel Pokorny, et al. (2024). Advancing Prone-Transpsoas Spine Surgery: A Narrative Review and Evolution of Indications with Representative Cases. Journal of clinical medicine, 13(4). p. 1112. 10.3390/jcm13041112 Retrieved from

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Khoi Duc Than

Professor of Neurosurgery

I chose to pursue neurosurgery as a career because of my fascination with the human nervous system. In medical school, I developed a keen interest in the diseases that afflict the brain and spine and gravitated towards the only field where I could help treat these diseases with my own hands. I focus on disorders of the spine where my first goal is to help patients avoid surgery if at all possible. If surgery is needed, I treat patients using the most advanced minimally invasive techniques available in order to minimize pain, blood loss, and hospital stay, while maximizing recovery, neurologic function, and quality of life. In my free time, I enjoy spending time with my family and friends. I am an avid sports fan and love to eat. I try to stay physically fit by going to the gym and playing ice hockey.


Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.


Deb Ashish Bhowmick

Associate Professor of Neurosurgery

I specialize in complex spinal and trauma surgery with a focus on pathology of the craniocervical junction, congenital spinal anomalies in adults, and cervical spinal deformities. I offer the highest quality of surgical care to improve or prevent the worsening of physical function. Whenever possible, I work with my patients to explore the non-surgical management of spinal conditions.


Muhammad Abd-El-Barr

Associate Professor of Neurosurgery

As a Neurosurgeon with fellowship training in Spine Surgery, I have dedicated my professional life to treating patients with spine disorders. These include spinal stenosis, spondylolisthesis, scoliosis, herniated discs and spine tumors. I incorporate minimally-invasive spine (MIS) techniques whenever appropriate to minimize pain and length of stay, yet not compromise on achieving the goals of surgery, which is ultimately to get you back to the quality of life you once enjoyed. I was drawn to medicine and neurosurgery for the unique ability to incorporate the latest in technology and neuroscience to making patients better. I will treat you and your loved ones with the same kind of care I would want my loved ones to be treated with. In addition to my clinical practice, I will be working with Duke Bioengineers and Neurobiologists on important basic and translational questions surrounding spinal cord injuries (SCI), which we hope to bring to clinical relevance.

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