Effect of patient position on the lordosis and scoliosis of patients with degenerative lumbar scoliosis

Han Fei, Wei-Shi Li, Zhuo-Ran Sun, Shuai Jiang, Zhong-Qiang Chen, Han Fei, Wei-Shi Li, Zhuo-Ran Sun, Shuai Jiang, Zhong-Qiang Chen

Abstract

This study aimed to analyze the effect of patient positions on the lordosis and scoliosis of patients with degenerative lumbar scoliosis (DLS).Seventy-seven patients with DLS were retrospectively analyzed. We measured lordosis and Cobb's angle on preoperative upright x-rays and magnetic resonance imagings in supine position. The lordosis and scoliosis of surgical segments in intraoperative prone position were measured on intraoperative radiographs of 20 patients to compare with that in standing position. Paired t tests were performed to investigate the parameters of the sample.From standing to supine position the whole lordosis increased (29.2 ± 15.7 degree vs. 34.9 ± 11.2 degree), and the whole scoliosis decreased (24.3 ± 11.8 degree vs. 19.0 ± 10.5 degree); 53 of 77 (68.8%) cases had increased lordosis, and 67 of 77 (87%) cases had decreased scoliosis. The lordosis of surgical segments in standing position had no difference with that in intraoprerative prone position. But in changing from supine/standing position to intraoprerative prone position, the scoliosis of surgical segments decreased (14.7 ± 9.4 degree vs. 11.4 ± 7.0 degree; 19.0 ± 11.8 degree vs. 11.4 ± 7.0 degree, respectively), and 18 of 20 (90%) cases had decreased scoliosis in intraoperative prone position than that in standing position.Compared with standing position in DLS patients, supine position increased lordosis and reduced scoliosis, and intraoperative prone position reduced scoliosis significantly. When evaluating the severity of DLS and making preoperative surgical plans, lumbar lordosis in supine position should also be evaluated in addition to upright x-ray, and the effects of different positions should be taken into consideration to reduce deviation.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
View of a patient positioned prone in a standard manner and the operating table. Two chest pads and 2 iliac pads were placed to allow the abdomen to hang free. The knees and shins were also placed on pads. The operating table was adjusted to make the hip and the knees in slight flexion.
Figure 2
Figure 2
Radiographic example of a patient (female, 63 years) with degenerative lumbar scoliosis in 3 positions: (A) preoperative upright posteroanterior radiograph shows 23.2 degree of scoliosis; (B) in preoperative MR in supine position the Cobb angle reduced to 17.3 degree. (C) Positioned prone during the process of pedicle screw insertion from L2 to L5, the Cobb angle further reduced to 10 degree.

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