{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T16:24:15Z","timestamp":1780503855305,"version":"3.54.1"},"reference-count":78,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Over the last few decades, many surgical techniques for lumbar interbody fusion have been reported. The anterior-to-psoas (ATP) approach is theoretically supposed to benefit from the advantages of both anterior and lateral approaches with similar complication rates, even in L5\u2013S1. At this segment, the anterior lumbar interbody fusion (ALIF) requires retroperitoneal dissection and retraction of major vessels, whereas the iliac crest does not allow the lateral transpsoas approach. This study aimed to investigate clinical-radiological outcomes and complications of the ATP approach at the L5\u2013S1 segment in a single cohort of patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This is a prospective single-center study, conducted from 2016 to 2019. Consecutive patients who underwent ATP at the L5\u2013S1 segment for degenerative disc disease or revision surgery after previous posterior procedures were considered for eligibility. Complete clinical-radiological documentation and a minimum follow-up of 12 months were set as inclusion criteria. Clinical patient-reported outcomes, such as the visual analog scale for low-back pain, Oswestry Disability Index, and 36-Item Short Form Health Survey (SF-36) scores, as well as spinopelvic parameters, were collected preoperatively, 6 weeks after surgery, and at the last follow-up visit. Intraoperative and perioperative complications were recorded. The fusion rate was evaluated on CT scans obtained at 12 months postoperatively.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Thirty-two patients met the inclusion criteria. The mean age at the time of surgery was 57.6 years (range 44\u201375 years). The mean follow-up was 33.1 months (range 13\u201348 months). The mean pre- and postoperative visual analog scale (7.9 \u00b1 1.3 vs 2.4 \u00b1 0.8, p < 0.05), Oswestry Disability Index (52.8 \u00b1 14.4 vs 22.9 \u00b1 6.0, p < 0.05), and SF-36 (37.3 \u00b1 5.8 vs 69.8 \u00b1 6.1, p < 0.05) scores significantly improved. The mean lumbar lordosis and L5\u2013S1 segmental lordosis significantly increased after surgery. The mean pelvic incidence\u2013lumbar lordosis mismatch and pelvic tilt significantly decreased. No intraoperative complications and a postoperative complication rate of 9.4% were recorded. The fusion rate was 96.9%. One patient needed a second posterior revision surgery for residual foraminal stenosis.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In the present case series, ATP fusion for the L5\u2013S1 segment has resulted in valuable clinical-radiological outcomes and a relatively low complication rate. Properly designed clinical and comparative trials are needed to further investigate the role of ATP for different L5\u2013S1 conditions.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2020.6.focus20335","type":"journal-article","created":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T06:32:03Z","timestamp":1598941923000},"page":"E14","source":"Crossref","is-referenced-by-count":24,"title":["The anterior-to-psoas approach for interbody fusion at the L5\u2013S1 segment: clinical and radiological outcomes"],"prefix":"10.3171","volume":"49","author":[{"given":"Massimo","family":"Miscusi","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Mental Health, and Sense Organs, \u201cSapienza\u201d University of Rome, Sant\u2019Andrea Hospital, Rome;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sokol","family":"Trungu","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Mental Health, and Sense Organs, \u201cSapienza\u201d University of Rome, Sant\u2019Andrea Hospital, Rome;"},{"name":"Neurosurgery Unit, Cardinal G. Panico Hospital, Tricase; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Ricciardi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Mental Health, and Sense Organs, \u201cSapienza\u201d University of Rome, Sant\u2019Andrea Hospital, Rome;"},{"name":"Neurosurgery Unit, Cardinal G. Panico Hospital, Tricase; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Forcato","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Cardinal G. 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