PTP (prone transpsoas) is a newer, single-position variation of lateral lumbar interbody fusion. It uses the same approach through the side and the psoas muscle as XLIF, but the patient is positioned face-down (prone) rather than on their side. This lets Dr. Chavarria place the interbody cage from the side and complete the posterior screws from the back without repositioning the patient, and the prone position tends to improve restoration of the spine's natural curve.
What Is PTP?
In a traditional lateral fusion, the patient lies on their side for the interbody portion and is then flipped onto their front for the posterior screws. PTP performs the entire operation with the patient prone, so both stages are done in a single position. This single-position approach can streamline the surgery and eliminate the time and effort of repositioning.
Positioning the patient prone allows the abdomen to hang freely, which helps the lower spine fall into a more natural curve (lordosis). Studies have found that PTP tends to achieve greater segmental lordosis correction than a standard lateral approach, an advantage when restoring alignment is a goal.
Like XLIF, PTP passes through the psoas muscle to reach the disc, so continuous nerve monitoring is used to protect the lumbar plexus. PTP is a more recently adopted technique with a growing body of supporting research, and it is best suited to the mid-lumbar levels typically addressed by lateral approaches.
Are You a Candidate?
- Patients needing a lateral lumbar interbody fusion who also require posterior screw fixation, done in a single position
- Patients in whom restoring lumbar curve (lordosis) and sagittal alignment is an important goal
- Patients with degenerative disc disease, spondylolisthesis, or degenerative scoliosis at the mid-lumbar levels
- Patients who are candidates for a lateral approach and may benefit from a streamlined, single-position operation
What to Expect
Pre-operative: Imaging is reviewed to plan the lateral corridor and the alignment goals. Nerve monitoring is planned to protect the nerves passing through the psoas.
Day of surgery: The interbody cage and the posterior screws are placed with the patient prone in a single position. Length depends on the number of levels; most involve a one to two-night stay.
First 4 weeks: As with other transpsoas approaches, some patients notice temporary thigh numbness, tingling, or hip-flexor weakness that typically improves within 4 to 12 weeks. Walking is encouraged; heavy activity is restricted.
3 to 6 months: Physical therapy begins around 4 to 6 weeks and X-rays track the fusion. Most patients return to full activity by 3 to 6 months.
Why Choose Dr. Chavarria for Your PTP in Reno?
- Single-position surgery, no need to reposition the patient between the interbody and posterior steps
- Improved restoration of lumbar curve (lordosis) and alignment from the prone position
- Retains the advantages of a large lateral interbody cage and indirect decompression
- Minimally invasive, with small incisions and low blood loss
- A modern, efficient approach for appropriately selected patients