The Effect of Operative Position on Lumbar Lordosis

Abstract

Study Design. The effect of intraoperative positioning on lumbar lordosis was retrospectively studied by radiographic analysis of 40 patients under general anesthesia. Objectives. The aim of this study was to document changes in segmental and total lumbar lordosis between preoperative standing and intraoperative radiographs taken in the “90-90” and prone positions. Summary of Background. Preservation of physiologic lordosis was an important consideration in reconstructive lumbar spine surgery. To avoid iatrogenic loss of lordosis when using spinal instrumentation and to facilitate decompressive procedures, it was necessary to understand how segmental alignments were affected by intraoperative positioning. Although many positioning techniques were used, the effect on lumbar lordosis was not well established. Methods. Preoperative (standing 36″ lateral spine) and intraoperative radiographs (lateral lumbar spine L1 to the sacrum) in either the “90-90” position on a Hastings frame (n = 20) or the prone position on a Jackson table (n = 20) were measured twice by two independent observers using Cobb methodology for total and segmental lordosis between L1 and S1. Data were analyzed for intra- and interobserver reliability and changes in segmental and total lordosis between standing and intraoperative radiographs. Results. Analysis of intra- and interobserver reliability revealed measurements were accurate and reproducible. The “90-90” position produced significant loss (P ≤ 0.01) of total and segmental lordosis at all levels except L1-L2, which showed no change. Segmental lordosis was reduced nearly 60% at L2-L3, L3-L4, and L4-L5, and total lordosis was reduced by more than 35%. The prone position on the Jackson table increased segmental lordosis at L5-S1 by 22% (P ≤ 0.01) and preserved total and segmental standing lordosis at all other levels. Conclusions. The “90-90” position on the Hastings frame was associated with significant reduction of total and segmental lordosis in the middle and lower lumbar spine. Positioning prone on a Jackson table maintained standing lumbar lordosis and increased lumbosacral lordosis.