Fan Zhang1, Haocheng Xu1, Bo Yin2, Hongyue Tao3, Shuo Yang1, Chi Sun1, Yitao Wang1, Jun Yin1, Minghao Shao1, Hongli Wang1, Xinlei Xia1, Xiaosheng Ma1, Feizhou Lu4,5, Jianyuan Jiang1. 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.
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.
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