Int J Spine Surg 2025, 19 (S1) S19-S27
• The prone lateral transpsoas (PTP) approach offers an alternative to traditional lateral lumbar interbody fusion (LLIF), allowing direct posterior access without repositioning the patient.
• Advantages of PTP include improved segmental lordosis, single-position surgery, and ease of posterior techniques, though it has a distinct learning curve.
• The technical guide aims to shorten the learning curve, optimize surgical workflow, and ensure patient safety through preoperative planning and technical adjustments.
• Preoperative imaging is crucial for assessing anatomical characteristics and guiding surgical approach decisions.
• Patient positioning in PTP involves prone positioning on a radiolucent table, with special attention to stabilizing the pelvis and optimizing working angles.
• Intraoperative monitoring with triggered electromyography (t-EMG) is essential to minimize lumbar plexus injury risk.
• Technical pearls include strategies for retractor positioning, minimizing retraction time, and using intraoperative navigation to enhance safety and efficiency.
• Conclusion: PTP LIF is a viable alternative to traditional methods, offering significant benefits but requiring mastery of its unique technical nuances.
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