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Eur Spine J. 2017 Mar;26(3):646-650. doi: 10.1007/s00586-016-4645-7. Epub 2016 Jun 7.

Does right lateral decubitus position change retroperitoneal oblique corridor? A radiographic evaluation from L1 to L5.

Author information

1
Department of Orthopedics, Huashan Hospital, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, China.
2
Shanghai Medical College, Fudan University, Shanghai, China.
3
Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
4
Department of Orthopedics, Huashan Hospital, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, China. lufeizhou@hotmail.com.
5
The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China. lufeizhou@hotmail.com.

Abstract

PURPOSE:

To determine if the retroperitoneal oblique corridor will be affected by right lateral decubitus position.

METHODS:

Forty volunteers were randomly enrolled and MRI scan was performed from L1 to L5 in supine and right lateral decubitus positions, respectively. In images across the center of each disc, O was defined as the center of a disc and A (supine) or A' (right lateral decubitus) was located in left lateral border of the aorta or the iliac artery; B (supine) or B' (right lateral decubitus) was on the anterior medial border of the psoas. The distance of AB and A'B' (Recorded as A-Ps and A-Pr, respectively) at each level was recorded and compared to each other. The relationships between A-Pr, sex, BMI and relative psoas cross-sectional area (PCSA) at each level were also evaluated.

RESULTS:

A-Pr was significantly smaller than A-Ps at L1/2, L2/3 and L3/4 (All p < 0.05); there was no significantly difference of A-Pr between all levels (p = 0.105), but L1/2 seemed to be larger than L3/4, followed by L2/3 and L4/5; A-Pr at each level was not affected by sex (All p > 0.05); linear relationships were found between A-Pr, BMI and PCSA at L1/2 and L3/4.

CONCLUSIONS:

ROC at L1/2, L2/3 and L3/4 will significantly decrease from supine to right lateral decubitus position and the reason may be due to the relaxed psoas deformation. Using MRI images in supine position for pre-operatively ROC evaluation is not accurate. Spine surgeon should also be more cautious when OLIF is performed at L4/5 where ROC is the smallest. Patients from Asia and those with strong psoas major at L1/2 and L3/4 are also associated with relatively narrow ROC.

KEYWORDS:

OLIF; Oblique corridor; Position change

PMID:
27272493
DOI:
10.1007/s00586-016-4645-7
[Indexed for MEDLINE]

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