RT Journal Article
SR Electronic
T1 Key Considerations in Surgical Decision-Making on the Side of Approach for Lumbar Lateral Transpsoas Interbody Fusion Techniques
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 8721
DO 10.14444/8721
A1 Owler, Brian
A1 Rajkumar, Vijidha Shree
A1 Wang, Yi Yuen
YR 2025
UL https://www.ijssurgery.com/content/early/2025/03/06/8721.abstract
AB Objectives Lumbar lateral transpsoas interbody fusion is a powerful technique for addressing various spinal pathologies, enabling effective anterior column reconstruction. A critical decision in performing this procedure is selecting the appropriate side for the approach to the lumbar spine, whether in the prone or lateral decubitus position. This article outlines a decision-making framework to assist surgeons in deciding the optimal approach for direct lateral surgery to achieve the desired surgical outcome.Study Design Technical note for lateral spinal fusion approaches.Methods The article explores anatomical considerations, surgical indications, and patient-specific factors relevant to the choice of approach in lateral lumbar transpsoas fusions. Through case examples, various factors influencing side selection are discussed.Results While many traditionally learn and perform direct transpsoas fusions through left-sided approaches, it is essential to consider pertinent anatomical features or variations, surgical pathologies, and patient-specific symptoms. The optimal side of the approach may vary based on these factors and remain key considerations for a holistic decision.Conclusions A thoughtful assessment of the factors highlighted here can significantly improve the likelihood of a successful prone or lateral transpsoas fusions. Although comprehensive studies are needed to better guide decisions between right- and left-sided approaches, surgeons currently rely on their clinical judgment and expertise to navigate these choices to maximize safety and efficacy for each patient.Clinical Relevance This study highlights minimizing surgical risk through holistic patient-centered decision-making.Level of Evidence 4.