P151. Three-year prone transpsoas (PTP) LLIF experience: clinical and radiographic outcomes and learnings following a consecutive 120 surgeries at a single center

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BACKGROUND CONTEXT PTP is a single-position alternative to the traditional lateral lumbar interbody fusion (LLIF) technique. Most reports over the last three years since its introduction have focused on technique description, feasibility, and early outcomes, including periop efficiencies and immediate postop radiographic alignment. Longer-term outcomes have been pending the maturity of this PTP experience. PURPOSE To document and report the followup outcomes of a novel method for single-position circumferential treatment of thoracolumbar conditions. STUDY DESIGN/SETTING Retrospective review of prospectively collected clinical and radiographic data PATIENT SAMPLE Consecutive single-cohort series of all patients in a single practice undergoing PTP for any indication between mid-2019 and mid-2022. OUTCOME MEASURES Pain (visual analog scale, VAS), function (Oswestry disability index, ODI), and quality of life (EQ-5D) were prospectively collected at preop and all postop clinic visits. Serial radiographs were measured to calculate spinopelvic alignment parameters. METHODS At a single institution, all consecutive PTPs were captured via prospective institutional registry to document demographic, diagnostic, and procedural details, as well as clinical (patient-reported) outcomes, and radiographic alignment measures. Retrospective database analysis identified 31 prone lateral approaches prior to proceduralization using procedure-specific positioners and retractor (PTP) and 89 proceduralized PTPs, enabling comparison across early and later cohorts. All cases used saphSSEP lumbar plexus monitoring. RESULTS The total cohort of 120 patients were 64% female, averaged 64 years (range: 26-84), had a mean BMI of 31 (range: 18-51), and included 27% with diabetes and 11% smokers. Diagnoses included spondylolisthesis, scoliosis, flatback, and adjacent-level degeneration. One PTP was aborted due to body habitus-related IONM challenges. In the 119 patients, 187 levels were treated (range: 1-5, average: 1.6/patient, 76% inclusive of L4-5), with 1-7 levels/patient of fixation, 38% with direct decompression, 8% with osteotomies, and 10% revision of prior hardware. OR time, retraction time, EBL, and LOS averaged 150 min, 17 min, 50 cc, and 2.2 days, respectively. There were 79% without complication; others included 3 cage repositionings, 1 partial ALL rupture, 1 durotomy, 1 epidural hematoma, 1 posterior wound infection, 1 pseudoarthrosis. Postop hip flexion weakness was identified in 14%, transient lower extremity weakness in 12%, and sensory deficits in 10%. Secondary surgeries included 2 adjacent-level decompressions, 1 pseudo revision, and 1 epidural hematoma evacuation. Followup averaged 13 months (range: 6 weeks-3 years). At last followup, back pain, worst-leg pain, ODI, and EQ-5D health state improved by 54%, 45%, 46, and 51%, respectively. Also, 89% said they were improved, 85% were satisfied, and 84% would elect the surgery again; 97% improved or maintained sagittal alignment with an average 6° segmental lordosis gain at PTP levels. Only intrapsoas retraction time differed between pre- and post-proceduralization; proceduralization saved a mean 3.4 min/level (p=0.0371). CONCLUSIONS The largest single-center PTP experience with the longest followup to-date shows that proceduralized PTP results in few complications, quick recovery, improvements in pain, function, and quality of life, high patient satisfaction, and improved sagittal alignment at an average 1-year and up to 3-year postop – outcomes consistent with this surgeon's prior lateral decubitus LLIF experience. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.

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