Prone positioning improves surgical access to the thoracolumbar junction – An MRI pilot study

Abstract

Background

The lateral decubitus position is the standard position for a lateral approach of the thoracolumbar junction, but prone positioning has been observed to increase the distance of abdominal organs from the spine in comparison to lateral decubitus position and gives a safe exposure to the lumbar spine.

Purpose

To compare distances between the thoracolumbar spine junction and abdominal structures between lateral decubitus and prone position.

Methods

Magnetic resonance imaging was conducted in two positions, lateral decubitus and prone, in six volunteers with no previous spine injury or complaints. Distances of abdominal structures from the spine were measured from Th10 to S1.

Results

In lateral decubitus position, abdominal structures shifted away from the thoracolumbar junction on the left side but became nearer to the spine on the right side. The distance of abdominal structures from the spine was highest in prone position, particularly on the right side.

Conclusions

These anatomical descriptions suggest that prone position can improve surgical access to the thoracolumbar junction in comparison to the standard lateral decubitus position, from the right side as well as from the left side.