Issue link: https://beckershealthcare.uberflip.com/i/1344229
34 Executive Briefing just enough space to place the interbody implant. Finally, the SafeOp neuromonitoring platform not only provides information regarding nerve location, but for the first time, we can reproducibly monitor the real-time health of the lumbar plexus throughout the procedure with saphenous SSEP monitoring. LP: The procedure comes with a full set of equipment that includes the patient positioning system, retractor, and SafeOp neuromonitoring - all of which are designed for the PTP approach. We developed the patient positioning system because in the traditional lateral approach, the table acts as a contralateral backstop while performing the procedure thereby eliminating patient movement. If you do the same surgery in the prone position, the patient could move. So, we needed a stable platform that would allow us to perform the PTP approach without the patient moving, while being able to coronally blend the patients with high crests. We also learned that the three-bladed retractor design common to traditional lateral procedures was not suited for this approach as it would easily lose its position due to its weight and lack of rigidity. We decided on a light-weight, two-bladed retractor that thoroughly maintains its position in accessing the disc space. Q: What pathologies have you been able to address with the procedure? LP: One of the most frequent pathologies we see is spondylolisthesis. With PTP, we are seeing an increased ability to treat this indication through the corrective properties of the prone position. We have experience now using PTP to treat pathologies ranging from single-level degenerative disc disease to multi-level deformities. WT: It's often that I have L4/5 spondylolisthesis patients. I can position them prone, which itself reduces the spondy and then use navigation to insert the pedicle screws. I can simultaneously do a PTP at L4/5 and a TLIF at L5/S1 without having to reposition the patient or worry about performing a laminectomy or decompression at L4/5. I can do the pro- cedure with all of the advantages of MIS surgery while hav- ing the patient in an ergonomically advantageous position. Q: What is the difference between PTP and other prone lateral offerings? LP: There are other companies trying to achieve similar results as PTP but with a lateral system they designed for the traditional lateral decubitus approach. But when patients are in a prone position, we cannot reproducibly perform surgery with a traditional lateral system. We learned that along the way and now have products specifically built from those learnings. This is not prone lateral, this is PTP. WT: Without the patient positioning system, even with taping and bolsters, the patient tends to slide across the table and the retractor disengages. The patient positioner keeps the patient stable with the retractor, which is anchored to the positioner. There are people who want to use the same instruments from the lateral decubitus procedure in prone, but I would caution against that. The PTP system has been specifically designed based on the learnings from over 1,000 cases and comes fully integrated as a procedural solution. Q: What do you see in the future for PTP? WT: In spine, we are moving to the outpatient setting and the pandemic has given us even more reasons to make the move. The ability to perform this surgery in the outpatient setting is nice because we've simplified the procedure in a way that doesn't require extra instruments, positioning, or time. The patient also experiences the advantages of minimally invasive lateral surgery with larger implants, high fusion rates and low subsidence in the outpatient setting. These all make PTP attractive. We are starting to use PTP on more complex cases as well, such as corpectomies and thoracic discectomies. It's nice to be able to perform these procedures with the patient in the prone position. We are constantly thinking about how to make PTP better. We want to grow the 20 to 30 percent of surgeons who are currently using the lateral approach because we think it's safer and better for the patient. n Luiz Pimenta, MD, PhD Neurosurgeon Director, Instituto de Patologia da Coluna São Paulo, Brazil William Taylor, MD Clinical Professor of Surgery Division of Neurosurgery, University San Diego, CA Pimenta, MD, PhD Neurosurgeon Director, Instituto de Patologia da Coluna Paulo, Brazil William Taylor, MD Clinical Professor of Surgery Division of Neurosurgery, University of California (UCSD) San Diego, CA