The Optimal Patient Position on the Surgical Table for Lateral Lumbar Interbody Fusion in Adult Spinal Deformity Using Three-Dimensional Computed Tomography: A Retrospective Study

Yosuke Ogata; Toshiaki Kotani; Takahiro Sunami; Shun Okuwaki; Shuhei Ohyama; Yasushi Iijima; Kotaro Sakashita; Shuhei Iwata; Kohei Okuyama; Tsuyoshi Sakuma; Tsutomu Akazawa; Shohei Minami; Seiji Ohtori; Masao Koda; Masashi Yamazaki

doi:10.22603/ssrr.2023-0146

The Optimal Patient Position on the Surgical Table for Lateral Lumbar Interbody Fusion in Adult Spinal Deformity Using Three-Dimensional Computed Tomography: A Retrospective Study

Spine Surg Relat Res. 2023 Oct 13;8(2):180-187. doi: 10.22603/ssrr.2023-0146. eCollection 2024 Mar 27.

Authors

Affiliations

¹ Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan.
² Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan.
³ Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
⁴ Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.

Abstract

Introduction: Lateral lumbar interbody fusion (LLIF) techniques have been extensively used in adult spinal deformity surgery. Preoperative knowledge of the optimal position of the patient on the surgical table is essential for a safe procedure. Therefore, this study aims to determine the optimal angle for positioning the patient on the surgical table during LLIF using three-dimensional computed tomography (3DCT).

Methods: Data from 59 patients (2 males, 57 females, mean age 66.3±8.6 years) with adult spinal deformities treated by performing corrective spinal surgery were included in this observational retrospective study. Simulated fluoroscopic images were obtained using 3DCT images rotated from the reference position with the spinous process of S1 as the midline to the position with the spinous process in the center of the bilateral pedicle of T12-L5. The rotation angle of each vertebra was measured and defined as the optimal rotation angle (ORA). The angle that bisected the angle between the maximum and minimum ORA was defined as the optimal mean angle of the maximum and minimum ORA (OMA) and considered the optimal angle for the patient's position on the surgical table, as this position could minimize the rotation angle of the surgical table during surgery. A multiple regression analysis was performed to predict OMA.

Results: Multiple regression analysis revealed the following equation: OMA=1.959+(0.238×lumbar coronal Cobb angle)+(-0.208×sagittal vertical axis).

Conclusions: When the patient is placed on the surgical table by rotating them at the OMA, the rotation of the surgical table can be reduced, ensuring a safe and efficient surgical procedure.

Keywords: Adult spinal deformity; Lateral lumbar interbody fusion; Optimal angle for setting the patient on the surgical table; Rotation of the surgical table; Simulated fluoroscopic image; Three-dimensional computed tomography.