Single-Position Prone Transpsoas Lateral Interbody Fusion at L4-L5: Technical Pearls

Single-position prone transpsoas (PTP) lateral interbody fusion has been proposed as an alternative to lateral lumbar interbody fusion performed in the lateral decubitus position. The advantages to this single-position technique include facilitating segmental lordosis, obviating the need for repositioning for posterior instrumentation, and providing access for posterior decompression. Although PTP lateral interbody fusion can be a powerful and efficient technique, adopting and navigating this approach is challenging. A learning curve should be expected, even for surgeons who are experienced with traditional lateral lumbar interbody fusion. This review provides a detailed technical description of the PTP technique at L4-L5. In addition, we provide technical pearls aimed at improving surgical ergonomics, workflow, and safety.