Prone transpsoas lumbar fusion is an advanced approach to lumbar interbody fusion that combines the benefits of a lateral approach with the efficiency of a single surgical position. During the procedure, the patient remains face-down (prone) while the surgeon accesses the disc space from the side of the spine through the psoas muscle. This allows the surgeon to perform the interbody fusion, place posterior instrumentation, and complete necessary posterior decompression without repositioning the patient. Traditional lateral lumbar interbody fusion (LLIF) typically requires the patient to be repositioned from a side-lying position to a prone position before completing the posterior portion of the operation. The prone lateral approach eliminates this additional positioning step, allowing the entire procedure to be performed in one position. For appropriately selected patients, this technique may provide advantages in surgical efficiency, restoration of lumbar alignment, and the ability to address multiple aspects of spinal reconstruction through a streamlined approach. As with any advanced surgical technique, the appropriate approach depends on the patient's anatomy, diagnosis, and individual treatment goals.
Key Facts at a Glance
- What it is. An advanced, single-position lumbar fusion technique that allows both the lateral interbody fusion and posterior screw fixation to be performed with the patient face-down (prone), eliminating the need for intraoperative repositioning.
- Why it is used. To restore disc height, relieve nerve compression through indirect decompression, improve lumbar lordosis and overall spinal alignment, and stabilize the affected spinal segment.
- Who performs it locally. Dr. Samia Ghaffar is the only spine surgeon in the Central Valley known to perform the prone lateral transpsoas lumbar fusion approach.
- Hospital stay. Most patients stay in the hospital for approximately two nights and begin walking the day after surgery.
- Recovery. Many patients resume light daily activities by 6 weeks, complete formal physical therapy by approximately 3 months, and gradually return to unrestricted activities over 6 months, depending on healing and individual recovery.
- Important to know. No single fusion technique is right for every patient. The optimal surgical approach is determined by your anatomy, diagnosis, and treatment goals. Prone lateral transpsoas fusion is one of several advanced lumbar fusion techniques Dr. Ghaffar offers to provide the most appropriate care for each individual patient.
(Recovery varies by patient. This is not medical advice for any individual case.)
What is prone lateral transpsoas lumbar fusion?
Lumbar fusion is a procedure that permanently joins two or more vertebrae to restore stability, relieve pain, and improve spinal alignment. Bone graft, interbody implants, and pedicle screw fixation are used to allow the vertebrae to heal into a single, solid segment. Depending on the patient’s anatomy and the condition being treated, fusion may be performed through an anterior (front), posterior (back), or lateral (side) approach. Lateral lumbar interbody fusion (LLIF) was developed as a minimally invasive technique that accesses the spine through the patient’s side. Working through the psoas muscle, the surgeon removes the damaged disc and places a large interbody cage between the vertebral bodies. Compared with traditional posterior approaches, the larger implant can more effectively restore disc height, improve spinal alignment, and indirectly decompress compressed nerve roots by restoring normal tension to the spinal ligaments.
Traditionally, LLIF is performed in two stages during the same operation. The lateral portion of the procedure is completed with the patient lying on their side. The patient is then repositioned face-down so the surgeon can place pedicle screws and perform any necessary posterior decompression. This additional positioning step increases operative time and interrupts surgical workflow.
Prone lateral transpsoas lumbar fusion is an evolution of this technique. The entire procedure is performed with the patient in a single face-down (prone) position. Through one surgical setup, the surgeon completes the lateral interbody fusion, places posterior instrumentation, and performs decompression when indicated—all without repositioning the patient. For appropriately selected patients, this streamlined approach may improve operative efficiency while allowing excellent restoration of lumbar lordosis and sagittal alignment.
As with all spine procedures, the choice of surgical approach is individualized. Dr. Ghaffar carefully selects the technique that best matches each patient’s anatomy, diagnosis, and treatment goals, recognizing that prone lateral fusion is one of several effective options for lumbar fusion.
Who is a candidate?
Prone lateral transpsoas lumbar fusion is one of several lumbar fusion approaches. It is not the right choice for every patient. The decision about which approach to use is made by the surgeon and the patient together, after a complete review of the patient’s symptoms, examination, and imaging.
Patients who may be considered for this approach typically have:
- A degenerative lumbar condition that has failed appropriate conservative management.
- Pathology at lumbar levels that are well suited to a lateral transpsoas approach.
- A need for restoration of disc height, indirect decompression of the nerve roots, or correction of segmental sagittal alignment.
- An anatomy that allows safe passage through the psoas muscle on the chosen side.
- The ability to tolerate general anesthesia and the prone position.
Patients who may not be good candidates include those with:
- Anatomical features that make a transpsoas corridor unsafe on either side.
- Conditions where another approach (anterior, posterior-only, or a different fusion strategy) is a better fit.
The best surgical approach is the one that is most appropriate for the patient's anatomy, diagnosis, and treatment goals. During your consultation, Dr. Ghaffar will review your imaging with you, explain the advantages and limitations of each reasonable surgical option, and discuss why a particular approach may—or may not—be the best choice for your specific condition. Every recommendation is individualized, evidence-based, and made collaboratively, ensuring you have a clear understanding of your options before any treatment decisions are made.
How the procedure is performed
The exact steps vary by patient, but the general flow is consistent.
- Anesthesia and positioning. The patient is brought to the operating room and given general anesthesia. The patient is then carefully positioned face-down on a specialized open frame that supports the chest and pelvis while leaving the abdomen free.
- Field preparation. The flank (side) and back are prepped and draped together so both surgical corridors are accessible without moving the patient.
- Lateral approach to the disc. The surgeon makes a small incision in the flank and uses fluoroscopy and intraoperative neuromonitoring to safely traverse the psoas muscle and reach the disc space.
- Discectomy and interbody placement. The damaged disc material is removed and a large interbody cage filled with bone graft material is placed across the disc space. The cage restores disc height and indirectly decompresses the nerve roots by re-tensioning the spinal ligaments.
- Posterior instrumentation. Without repositioning the patient, the surgeon then accesses the posterior spine to place pedicle screws and rods. This stabilizes the segment while the bone graft heals into a fusion.
- Posterior decompression if needed. If the patient also requires direct decompression (a laminectomy, for example), it is performed at this stage from the same prone position.
Throughout the procedure, intraoperative neuromonitoring provides continuous feedback on the function of the spinal cord and lumbar nerve roots. This is standard practice for every instrumented case Dr. Ghaffar performs.
Recovery and what to expect
Recovery from any lumbar fusion is a process that unfolds over months, not days. The recovery snapshot below reflects the typical timeline for Dr. Ghaffar’s lumbar fusion patients. Individual recovery varies. This is not medical advice for any specific case.
Common postoperative findings to expect
Some hip flexor soreness or transient weakness on the side of the surgical approach is well documented after any transpsoas approach, including prone lateral. This is a known finding that is discussed with patients before surgery, and most symptoms improve over weeks. Dr. Ghaffar discusses this and other expected postoperative findings with each patient before surgery.
Why Dr. Ghaffar performs prone lateral transpsoas
Dr. Ghaffar adopted the prone lateral transpsoas approach because it allows her to deliver several things that matter for lumbar fusion outcomes in a single, efficient surgical workflow:
- Better segmental lordosis restoration and sagittal alignment control than the dual-position lateral workflow.
- Stable, simultaneous access for posterior decompression and instrumentation alongside the interbody work, without taking the patient down and repositioning.
- A more efficient operative workflow that may reduce operative time and infection risk.
- Less operative variability by removing the repositioning step from the surgical timeline.
She is the only surgeon performing this approach in town. It is offered when the patient’s anatomy and pathology call for it, never as a default and never as a marketing claim. The right approach for any individual patient is the approach that matches the patient.
When prone lateral transpsoas is NOT the right answer
A core part of Dr. Ghaffar’s surgical philosophy is that the right operation is the one the patient actually needs. Prone lateral transpsoas is not the right answer when:
- The patient’s symptoms do not yet warrant surgery and conservative care has more to offer.
- The patient’s anatomy makes a transpsoas corridor unsafe on both sides.
- A different fusion approach (anterior, posterior-only, or a non-fusion procedure) is a better fit for the pathology and goals.
- The patient simply does not want surgery and has options remaining.
A consultation that ends with a recommendation against surgery is just as valuable as one that ends with a surgical plan.
When to seek prompt evaluation
Most lumbar conditions are not emergencies. However, certain symptoms should be evaluated promptly, regardless of whether surgery is on the table:
- New or progressive weakness in one or both legs
- Loss of bowel or bladder control
- Numbness in the saddle area (the part of the body that would touch a saddle)
- Severe, sudden, or rapidly worsening back or leg pain
- Pain that wakes you from sleep and does not improve with position changes
If any of these symptoms are present, urgent medical evaluation is appropriate. Cauda equina syndrome, a rare emergency caused by severe compression of the cauda equina nerves, requires immediate treatment.
Next Steps
If you have been told you may need a lumbar fusion or are considering your surgical options, Dr. Ghaffar welcomes the opportunity to provide a comprehensive evaluation. During your consultation, she will review your imaging with you, explain your diagnosis in detail, and use a spine model to demonstrate the proposed procedure, its goals, and any appropriate alternatives. Every recommendation is individualized, ensuring you have a clear understanding of your condition and the confidence to make an informed decision about your care.
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Every treatment decision is highly individualized. Consult a qualified spine surgeon to determine the appropriate treatment for your condition.
Medically reviewed by
Samia Ghaffar, MD
Board-Certified Orthopaedic Spine Surgeon