Compared to the traditional open posterior lumbar interbody fusion (PLIF) and anterior lumbar interbody fusion (ALIF), minimally invasive surgical techniques for LIF have become increasingly popular in the treatment of degenerative spinal pathologies1. In the 1980s, the transforaminal LIF (TLIF) emerged as a minimally invasive alternative that required less traction on the dura and transversing nerve roots. Compared to PLIF, TLIF was associated with reduced operative time and morbidity2. Minimally invasive LIF techniques gained even more traction when the lateral lumbar interbody fusion (LLIF) was introduced by Pimenta in 20013. By approaching the spine laterally via the retroperitoneal fat and psoas major muscle, the posterior tension bands could be maintained, while also avoiding anterior transperitoneal structures4. In 2006, this was established further by Ozgur et al., who described the extreme lateral LIF (XLIF) technique with the use of special patented retractors, transversing through two 3-4 cm incisions5. This technique permits the placement of large-footprint interbody cages, decreasing the likelihood of subsidence while also causing less blood loss, decreased pain, and fewer infections when compared to open posterior approaches[6], [7], [8].

Despite its benefits, the lateral transpsoas (LLIF/XLIF) approach is less efficient in cases involving instability or malalignment, which necessitate posterior pedicle screw supplementation9. Traditionally in the lateral transpsoas technique, patients undergo lateral interbody placement in a 90 ° right lateral decubitus position, followed by repositioning to prone for open or percutaneous posterior pedicle screw fixation. This repositioning requires a second round of preparation, draping, and reorientation of the operating room, increasing operative time by an average of 31 minutes in one study10. To address this inefficiency, Pimenta et al. introduced the prone transpsoas (PTP) technique, which allows access to both anterior lumbar spine and posterior midline spine via a single position3, eliminating the need for repositioning and improving surgical efficiency. Moreover, the prone single position approach facilitates improved segmental lordosis correction in single-level spondylolisthesis cases, as the patient’s abdomen hangs freely on a Jackson table, aiding natural abdominal decompression and restoration of sagittal alignment during fusion11. While recent studies have demonstrated that single position prone LLIF yields favorable outcomes in terms of operational time, hospital stay, staffing requirements, blood loss, radiation exposure, complications, and reoperations, further studies are warranted to validate its long-term safety, efficacy and durability across diverse populations[12], [13], [14], [15], [16].