Introduction:

Prone transpsoas lateral lumbar interbody fusion (PTP-LLIF) is a recently introduced modification to standard-LLIF. To date, no study has compared the radiographic outcomes of standard-LLIF and PTP-LLIF. This study aimed to perform a radiographic parameter-based propensity score-matched analysis to compare postoperative clinical and radiographic outcomes between PTP-LLIF and standard-LLIF for degenerative lumbar spine disease.

Methods:

A total of 30 consecutive patients met the inclusion : riteria. Preoperative standing scoliosis x-rays were retrospectively reviewed for global and segmental sagittal alignment. Propensity matching was calculated using baseline radiographic parameters. One-to-one matching of patients who had undergone PTP-LLIF with those who had a similar propensity score but had undergone standard-LLIF was performed to compare radiographic (primary) and clinical (secondary) outcomes.

Results:

Propensity score matching resulted in 10 pairs of PTP-LLIF and standard-LLIF patients. The PTP-LLIF group had significantly better improvement in lumbar lordosis (p=0.047). Improvement in pelvic incidence minus lumbar lordosis mismatch approached statistical significance in that group (p=0.05). This led to better improvement in short form-12 physical score (SF12-PS) (p=0.03) and Oswestry disability index (p=0.1) in the PTP-LLIF group. There were no significant differences between groups in other clinical and radiographic outcomes. PTP-LLIF had non-significantly shorter operative time (p=0.4) and hospital stay (p=0.1) as well as less radiation exposure time (p=0.5). Standard-LLIF had non-significantly less intraoperative bleeding (p=0.3). Mean follow-up was 10.2±5.2 months in the PTP-LLIF group versus 30.9±17.2 months in the standard-LLIF group (p<0.05).

Conclusion:

PTP-LLIF showed significantly better improvement in lumbar lordosis and SF12-PS.