Simultaneous prone transpsoas interbody fusion and osteotomies for severe deformity correction: multi-institutional retrospective review.
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2026-01
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Background
The increasing prevalence of adult spinal deformity (ASD) highlights the need for effective treatment strategies. While minimally invasive spine surgery has improved outcomes, patients with severe deformity often require more extensive correction. This study evaluates the outcomes of combining prone transpsoas (PTP) lumbar interbody fusion with posterior column osteotomies (PCO) or pedicle subtraction osteotomies (PSO) for severe ASD correction.Methods
This retrospective, multicenter cohort study evaluated pre- and postoperative changes in 15 patients with severe ASD [minimally invasive spinal deformity revision 2 (MISDEF2) class III/IV] treated with a hybrid approach combining PTP with simultaneous PSO or PCO. Radiographic spinopelvic parameters included pelvic incidence-lumbar lordosis (PI-LL) mismatch, sagittal vertical axis (SVA), T1 pelvic angle (TPA), segmental lordosis (SL), and coronal Cobb angle. Patient-reported outcomes included Oswestry Disability Index (ODI) and Visual Analogue Scale scores for back (VAS-B) and leg (VAS-L) pain. Differences between pre- and post-operative outcomes were assessed with paired t-tests, and Spearman's rank coefficients were used to evaluate correlations.Results
Complication rates were similar between PCO and PSO patients. Significant improvements were observed in lumbar lordosis (LL) (P=0.002), SVA (P=0.03), TPA (P=0.04), coronal Cobb angle (P=0.03), and PI-LL mismatch (P=0.003). SL did not change significantly at any level. Clinically, ODI, VAS-B, and VAS-L scores improved significantly (P<0.001 for all). Correlations showed moderate to strong negative associations between SL at L2-L3 and patient-reported outcomes.Conclusions
Combining PTP with PCO or PSO provides significant radiographic and clinical improvements in severe ASD patients. This hybrid approach may serve as a safe, efficient alternative to traditional multistage open surgeries, warranting further prospective validation.Type
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Bartlett, Alyssa M, Peter N Drossopoulos, Felix S Toussaint, Oluwatobi O Onafowokan, Quinn Steiner, Khoi D Than, Clifford Crutcher, Christopher I Shaffrey, et al. (2026). Simultaneous prone transpsoas interbody fusion and osteotomies for severe deformity correction: multi-institutional retrospective review. Journal of spine surgery (Hong Kong), 12(1). p. 1. 10.21037/jss-25-123 Retrieved from https://hdl.handle.net/10161/34203.
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Scholars@Duke
Khoi Duc Than
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
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
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
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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