Decubitus Position Research Articles

Application of modified Frosch approach for Schatzker typeⅡtibial plateau fractures with posterolateral column

To explore clnical efficacy of modified Frosch approach for Schatzker typeⅡtibial plateau fracture with posterolateral column. From January 2019 to September 2020, totally 11 patients with Schatzker typeⅡtibial plateau fractures with posterolateral column were treated, including 7 males and 4 females, aged from 21 to 49 years old. Modified Frosch approach was adopted for lateral decubitus position, and posterolateral fractures were fixed with support plates or posterolateral screws. Anterolateral fixation with conventional tibial plateau lateral locking plate. Tibial plateau varus angle and posterior inclination angle were measured by X-ray immediately and 12 months after operation, as well as knee motion at 12 months after operation. Knee function at 12 months after operation was evaluated by knee score of Hospital for Special Surgery(HSS). Eleven patients were followed up for 12 to 15 months. Varus angle and inclination angle at immediately after operation ranged from 76° to 86° and 6° to 10°, respectively, and 79° to 88° and 6° to 10°, respectively at 12 months after operation. The range of extension of knee ranged from 0° to 5°, and flexion was 106° to 137° at 12 months after operation. Postoperative HSS knee score at 12 months ranged from 74 to 94 scores, 8 patients were excellent and 3 good. Modified Frosch approach is an effective surgical method for Schatzker typeⅡtibial plateau fracture with posterolateral column. A single incision is used to complete fracture exposure and fixation at two sites, avoiding use of combined incisions, and could obtain good postoperative knee joint function. During operation, popliteal fossa structure should be familiar, and the common peroneal nerve should be protected to avoid injury.

Prevalence of Aspiration Risk due to a Full Stomach Assessed by Gastric Ultrasonography in Diabetic Patients Undergoing Non-Emergency Surgery

Background: Pulmonary aspiration causes severe complications and high mortality, especially in diabetic patients during the perioperative period. Gastric ultrasonography is able to detect a patient with full stomach that poses high risk of pulmonary aspiration. However, in Thailand, there is no previous prevalence study. Objective: To study the prevalence of aspiration risk resulting from full stomach in diabetic patients during non-emergency surgery and to identify related risk factors using gastric ultrasonography. Materials and Methods: One hundred nineteen diabetic patients were enrolled between July 2021 and January 2022. A preoperative ultrasound examination of gastric content was performed in the right lateral decubitus position. Aspiration risk due to full stomach was defined as having solid contents or fluid volume more than 1.5 mL/kg. The associated risk factors were analyzed using multiple logistic regression models. Results: The prevalence of aspiration risk due to “full stomach” was 18.49% (22 out of 119 patients). Age between 65 and 84 years old (adjusted OR 015, 95% CI 0.04 to 0.54) and blood urea nitrogen (BUN) levels (adjusted OR 1.04, 95% CI 1.00 to 1.08) were statistically significantly associated risk factors (p<0.05). There was no incidence of pulmonary aspiration during the study period. Conclusion: While diabetic patients were advised to follow standard fasting guidelines, the risk of pulmonary aspiration persisted. Implementing an anesthetic plan as though the patient belonged to the “full stomach” group helped ensure the patient’s safety. Additionally, preoperative gastric ultrasound assessment is able to detect “full stomach” condition, thereby, further reducing the incidence of pulmonary aspiration.

Lateral Spinal CSF Leaks in Patients with Spontaneous Intracranial Hypotension: Radiologic-Anatomic Study of Different Variants.

Spinal CSF leaks cause spontaneous intracranial hypotension. Several types of leaks have been identified, and one of these types is the lateral dural tear. Performing myelography with the patient in the decubitus position allows precise characterization of these leaks. The purpose of the current study was to describe the different variants of spontaneous lateral CSF leaks. This retrospective cohort study included a consecutive group of patients with spontaneous intracranial hypotension and lateral CSF leaks who underwent digital subtraction myelography in the decubitus position and underwent surgery to repair the CSF leak between July 2018 and June 2023. The mean age of the 53 patients (37 women and 16 men) was 35.5 years. Three different variants of lateral CSF leak could be identified. Forty-nine patients (92.5%) had a lateral dural tear associated with the nerve root sleeve. The dural tear was at the axilla of the nerve root sleeve in 36 patients (67.9%) and at the shoulder in 13 patients (24.5%). Four patients (7.5%) had a lateral dural tear at the level of the pedicle that was not associated with the nerve root sleeve. Findings on digital subtraction myelography were concordant with intraoperative findings in all patients. An extradural CSF collection was seen in all patients with a lateral dural tear associated with the nerve root sleeve but in only 2 of the 4 patients with the pedicular variant of a lateral dural tear. We identified 3 variants of spontaneous lateral dural tears. Most lateral dural tears are associated with extradural CSF collections and arise from either the axilla (67.9%) or the shoulder (24.5%) of the nerve root sleeve. Lateral dural tears at the level of the pedicle (7.5%) not associated with the nerve root sleeve are uncommon and may require specialized imaging for their detection.

A comparative study using gastric ultrasound to evaluate the safety of shortening the fasting time before pediatric echocardiography: a randomized controlled non-inferiority study.

The objective of this study was to demonstrate that the gastric cross-sectional area (CSA) in the right lateral decubitus position (RLDP) during a 2-h fasting period is not larger than that during a conventional 4-h fasting period prior to pediatric echocardiography. 93 patients aged under 3years scheduled for echocardiography under sedation were enrolled and randomly allocated into two groups; 2-h fasting vs 4-h fasting. For group 4h (n = 46), the patients were asked to be fasted for all types of liquid for more than 4h, while group 2h (n = 47) were asked to be fasted for all types of liquid for 2h before echocardiography. Gastric ultrasound was performed before echocardiography, and CSARLDP was measured. We compared CSARLDP, incidence of at-risk stomach, fasting duration, and the incidence of major (pulmonary aspiration, aspiration pneumonia) and minor complications (nausea, retching, and vomiting, apnea, and bradycardia) between two groups. The mean difference of CSARLDP (group 2h-group 4h) was 0.49 (-0.18 to 1.17) cm2, and it was within the non-inferiority margin (Δ = 2.1 cm2). There was no difference in the incidence of at-risk stomach (P = 0.514). There was no significant difference in the incidence of major and minor complications between the two groups. Two-hour fasting in pediatric patients who need an echocardiography did not increase major and minor complications and CSA significantly.

Advanced Sonographic Techniques in the Comprehensive Evaluation and Diagnosis of Male Infertility.

Background Infertility affects many couples, with male factors being responsible for over half of the cases. Male infertility can arise from various testicular illnesses, such as varicocele and cryptorchidism, as well as posttesticular disorders, like ejaculation abnormalities. Infertility is defined as the inability to conceive after 12 months of unprotected sexual activity or after six months for women over 35. Diagnostic techniques such as semen analysis and scrotal ultrasonography are done to evaluate conditions like varicocele and epididymo-orchitis. This study aims to assess the diagnostic utility of ultrasonography for male infertility and compare its findings with those from surgery and clinical care. Methodology All patients were referred to the Department of Radiology,Tertiary Care Hospital, South India, for transrectal and scrotal ultrasonography, using a high-frequency transducer with a frequency of 7.5 MHz and a color Doppler when necessary. The study included all male patients with infertility and abnormal semen analysis, as well as those with infertility accompanied by scrotal abnormalities detected during clinical examination. Patients were placed in the left lateral decubitus position for the transrectal ultrasonography examination. The testes and epididymis were thoroughly examined on both sides and compared regarding symmetry, size, texture, and vascularity. Results Varicocele was the most frequent anomaly detected by both clinical examination and ultrasonography. Ultrasound detected 30 cases of varicocele, whereas clinical examination diagnosed 15 cases. Hydrocele was identified in eight cases through clinical examination and in 15 cases through ultrasound. Epididymal cysts were found in five cases via clinical examination, while both clinical examination and ultrasonography discovered epididymitis in 10 cases. Overall, the number of anomalies detected by ultrasound was significantly higher than those found by physical examination, with a statistically significant p value of 0.001. Conclusion Transrectal ultrasound provides high-resolution imaging of the prostate, seminal vesicles, and distal vas deferens, which aids in diagnosing obstructive azoospermia. Imaging is a valuable supplement to clinical examination and laboratory studies for accurately identifying anatomy and abnormalities. Both transrectal and scrotal ultrasonography offer crucial information in diagnosing male infertility. Ultrasonography is more effective in identifying pathological abnormalities than clinical palpation.

A novel imageless accelerometer-based navigation system improves acetabular cup placement accuracy during total hip arthroplasty in the lateral decubitus position.

The accuracy of acetabular cup placement using conventional portable imageless navigation systems in total hip arthroplasty (THA) in the lateral decubitus position remains challenging. Several novel portable imageless navigation systems have been developed recently to improve cup placement accuracy in THA. This study compared the accuracy of acetabular cup placement using a conventional accelerometer-based portable navigation (c-APN) system and a novel accelerometer-based portable navigation (n-APN) system during THA in the lateral decubitus position. This retrospective cohort study compared 45 THAs using the c-APN and 45 THAs using the n-APN system. The primary outcomes were the absolute errors between the intraoperative and postoperative values of acetabular cup radiographic inclination and anteversion angles and the percentage of cases with absolute errors within 5°. Intraoperative values were shown on navigation systems, and postoperative measurements were conducted using computed tomography images. The median absolute errors of the cup inclination angles were significantly smaller in the n-APN group than in the c-APN group (3.9° [interquartile range 2.2°-6.0°] versus 2.2° [interquartile range 1.0°-3.3°]; P = 0.002). Additionally, the median absolute errors of the cup anteversion angles were significantly smaller in the n-APN group than in the c-APN group (4.4° [interquartile range 2.4°-6.5°] versus 1.9° [interquartile range 0.8°-2.7°]; P < 0.001). Significant differences were observed in the percentage of cases with absolute errors within 5° of inclination (c-APN group 67% versus n-APN group 84%; P = 0.049) and anteversion angles (c-APN group 62% versus n-APN group 91%; P = 0.001). The n-APN system improved the accuracy of the cup placement compared to the c-APN system for THA in the lateral decubitus position.

Simplified supine modified park bench / lateral decubitus position using a shoulder pad and a Mayfield head clamp for neurosurgical approach to lesions located in the occipital lobe or the posterior fossa: technical note.

Neurosurgical approach to lesions located in the occipital lobes or in the posterior fossa require very specific and time-consuming patient installations, such as the park bench position, the prone position, or the sitting position. Nevertheless, each of these position present major drawbacks regarding specific installation-related adverse events and potentially serious neurosurgical complications such as venous air embolism, iatrogenic intracranial hypertension, and supratentorial remote hematoma just to cite a few. In order to provide neurosurgeons with a simpler, physiologically-respective, easily tolerated, less time-consuming, and less provider or specific adverse events patient installation, Ochiai (1979) introduced the supine modified park-bench / lateral decubitus position. Given that this patient position has not gained wide visibility among the neurosurgical community despite its obvious numerous advantages over its classic counterparts, we provide our experience using this installation for neurosurgical approach to lesions located in the occipital lobes and in the posterior fossa.

Retrospective study comparing the accuracies of handheld infrared stereo camera and augmented reality-based navigation systems for total hip arthroplasty.

The use of portable navigation systems (PNS) in total hip arthroplasty (THA) has become increasingly prevalent, with second-generation PNS (sPNS) demonstrating superior accuracy in the lateral decubitus position compared to first-generation PNS. However, few studies have compared different types of sPNS. This study retrospectively compares the accuracy and clinical outcomes of two different types of sPNS instruments in patients undergoing THA. A total of 158 eligible patients who underwent THA at a single institution between 2019 and 2022 were enrolled in the study, including 89 who used an accelerometer-based PNS with handheld infrared stereo cameras in the Naviswiss group (group N) and 69 who used an augmented reality (AR)-based PNS in the AR-Hip group (group A). Accuracy error, navigation error, clinical outcomes, and preparation time were compared between the two groups. Accuracy errors for Inclination were comparable between group N (3.5° ± 3.0°) and group A (3.5° ± 3.1°) (p = 0.92). Accuracy errors for anteversion were comparable between group N (4.1° ± 3.1°) and group A (4.5° ± 4.0°) (p = 0.57). The navigation errors for inclination (group N: 2.9° ± 2.7°, group A: 3.0° ± 3.2°) and anteversion (group N: 4.3° ± 3.5°, group A: 4.3° ± 4.1°) were comparable between the groups (p = 0.86 and 0.94, respectively). The preparation time was shorter in group A than in group N (p = 0.036). There were no significant differences in operative time (p = 0.255), intraoperative blood loss (p = 0.387), or complications (p = 0.248) between the two groups. An Accelerometer-based PNS using handheld infrared stereo cameras and AR-based PNS provide similar accuracy during THA in the lateral decubitus position, with a mean error of 3°-4° for both inclination and anteversion, though the AR-based PNS required a shorter preparation time.

Antegrade cerebral perfusion via the right subclavian artery during open distal arch or proximal descending aortic repair from left thoracotomy.

In the current endovascular era, open surgery through left posterolateral thoracotomy with moderate to deep hypothermic circulatory arrest remains an alternative for treating chronic distal arch or proximal descending aortic diseases, allowing cardiovascular surgeons to definitively repair the aorta in a single stage. When utilizing this approach, this report illustrates an alternative surgical technique for antegrade body perfusion during cooling, antegrade selective cerebral perfusion and rewarming, through a prosthetic graft on the right subclavian artery. This report shows the safety and feasibility of this technique during open distal arch and/or proximal descending aortic surgery through left posterolateral thoracotomy, after shifting the patient from a supine to the right lateral decubitus position.

Urinary hydration biomarkers, but not renal blood velocity, are impacted by a 161-km ultra-endurance footrace

PURPOSE: Recent data suggest that dehydration (i.e., increases in urine specific gravity (USG) and osmolality (OSM)) may contribute to increased risk of acute kidney injury (AKI) [1]. AKI may be transiently elevated in a substantial proportion of athletes upon completing ultra-endurance running events (42km) [2], indicating potential kidney strain via reductions in renal perfusion. However, there are limited data on the effects of ultra-endurance running events on renal blood velocity (RBV). Therefore, we sought to investigate the effects of the 2023 161-km Western States Endurance Run (WSER) on hydration biomarkers and RBV. We hypothesized that USG and OSM would be higher and that RBV would be lower post- versus pre-race. METHODS: We included 17 participants (3F/14M, 44±10yrs, 175±7cm, 69±9kg) with urine samples and RBV data in this analysis. We measured USG with a refractometer and OSM with an osmometer. We assessed RBV in the decubitus position using sonography at the renal and segmental arteries (GE Logiq e). Renal vascular conductance, the ease with which blood flows through kidney vasculature, was calculated as RBV/supine central mean blood pressure (SphygmoCor XCEL). Pre-race measures were collected ≤72 hours before WSER and post-race measures were collected ≤1 hour after finishing. Normality was assessed and paired, two-sided t-tests or Wilcoxon paired tests were used to compare pre- vs. post-race measures. Normalized differences were calculated ([pre-post]/pre) to assess associations between variables using Pearson’s correlation. We set α a priori to ≤ 0.05. Results: The WSER elicited an increase in USG (1.010±0.007 vs 1.026±0.011, p=0.002) and urine OSM (420±220 vs 740±305 mOsm/kg, p=0.003). However, RBV was unaffected post-race in the renal (49.3±10.0 vs 44.6±13.4 cm·s−1, p=0.285) and segmental artery (28.9±6.4 vs 27.5±1.6 cm·s−1, p=0.345). There were no differences in vascular conductance in the renal (0.55±0.10 vs 0.53±0.19 cm·s−1/mmHg, p=0.808) or the segmental artery (0.325±0.02 vs 0.325±0.02 cm·s−1/mmHg, p=0.903). No associations were observed between changes in RBV and changes in hydration biomarkers ( ps&gt;0.243). CONCLUSIONS: We observed large elevations in USG and OSM, which may suggest a transient increase in workload within the kidneys, but no change in renal or segmental artery vascular conductance after WSER. Future analyses are needed to investigate whether AKI biomarkers may be elevated after the completion of ultra-endurance events, particularly among higher-risk runners. National Institutes of Health K01HL160772 (JCW), American Heart Association 23CDA1037938 (JCW), Western States Endurance Run Medical Research Program (GJG), NIH-K01HL147998 (ATR), Auburn University Offce of Vice President for Research Support Program (ATR). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

An Adult with Acute Breathlessness and Unilateral Diffuse Alveolar Opacities

Abstract Cardiogenic pulmonary edema is typically bilateral and results from the accumulation of excessive fluid in the interstitial and alveolar spaces of the lungs caused by left ventricular failure. Cardiogenic unilateral pulmonary edema (CUPE) is uncommon and most often documented in severe mitral regurgitation. CUPE in other cardiac diseases such as coronary artery disease is rare and occasionally associated with prolonged lateral decubitus position or vascular perfusion mismatch between lungs either congenital such as pulmonary artery agenesis or acquired due to preexisting lung conditions such as compensatory emphysema following lobectomy. The radiologic opacities of CUPE does not have characteristic features as described with bilateral pulmonary edema. The possibility of CUPE is often not considered initially as its clinical/radiologic features often resemble or are mistaken as pneumonia resulting in diagnostic delay and higher mortality.

Double Row Rotator Cuff Repair for Massive Reparable Rotator Cuff Tear

Background: Massive rotator cuff tears, defined as those that involved 2 or more tendons or where the length of the greatest diameter is greater than 5 cm, present a unique surgical challenge as there can be significant scarring, retraction, and poor tissue quality. Furthermore, healing of these tears is less reliable. This video presents our technique for anatomic, double row repair of a massive reparable rotator cuff tear. Indications: Indications for operative intervention include acute traumatic tears, as well as patients with pain and weakness who have failed to respond to conservative management, including physical therapy with confirmed large full thickness rotator cuff tear on advanced imaging. Of note, findings such as glenohumeral osteoarthritis, advanced muscle atrophy (Goutalier III/IV), superior migration of the humeral head &gt;7 mm, and tears larger than 40 mm in length and width are concerning for irreparable tears, and may represent contraindications to surgical repair. Technique Description: The patient is placed in the lateral decubitus position. After diagnostic arthroscopy is performed, a subacromial bursectomy is performed. A radiofrequency probe and arthroscopic shaver are used to perform releases in the subacromial space as well as superior to the glenoid. Preparation of the footprint of the humeral head is then performed to create a good healing surface. The rotator cuff is grasped to confirm tension free mobilization. The medial row anchors are then placed. Once placed, the sutures are incorporated into 2 lateral row anchors in sequential fashion. Subacromial decompression is then performed. Results: Reduced pain and improved shoulder function are the goals of treatment, with sling immobilization lasting for roughly 6 weeks postoperatively prior to initiating strengthening and range of motion protocols. Discussion/Conclusion: Arthroscopic double row repair produces an anatomic and stable reduction of reparable massive rotator cuff tears for patients that have failed conservative management. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Intraoperative Hypoxemia in the Right Lateral Decubitus Position: A Case Report

Platypnea-Orthodeoxia syndrome (POS), an exceptionally uncommon condition, is characterized by decreased oxygen saturation in an upright posture with corresponding improvement in the supine position. Recently, an 85-year-old female patient presented for surgery due to a left femoral neck fracture. Following successful tracheal intubation and anesthesia induction, the ventilator indicated an airway pressure of 15mmHg. While in the right lateral decubitus position, the patient developed hypoxia despite normal arterial blood pressure and symmetrical breath sounds. Attempts to alleviate the hypoxia through pure oxygen ventilation, tympanic lung ventilation, and high-frequency ventilation were unsuccessful. Subsequently, there was a notable decrease in both blood pressure and heart rate, prompting an immediate halt to the surgery and repositioning the patient to the supine position. This resulted in the normalization of the patient&amp;apos;s heart rate, oxygen saturation, and blood pressure. To investigate the etiology, a TEE probe was inserted, revealing the presence of a patent foramen ovale (PFO) and a significant right-to-left shunt while the patient was in the lateral position. The procedure was performed in a specific right lateral decubitus position. This case may represent a unique manifestation of POS syndrome, expanding the differential diagnosis for intraoperative position-related hypoxemia. Given the severe hypoxemia observed with intraoperative positional changes, a strong suspicion of POS syndrome is warranted.

Accuracy of portable navigation during THA in patients with severe developmental dysplasia of hip.

Correct cup placement in total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH) is considerably difficult. This study aimed to analyze the orientation accuracy of cup insertion during THA using a portable navigation system in patients with DDH. In this retrospective cohort study, we analyzed data from 64 patients who underwent THA using infrared stereo camera-matching portable navigation. Patients underwent THA via the anterolateral approach in the lateral decubitus position. Navigation records for intraoperative cup angles, postoperative cup angles measured on computed tomography (CT) images, and cup angle measurement differences were measured and compared between patients with non-DDH/mild DDH and severe DDH. Furthermore, the predictive factors for outliers of accurate acetabular cup placement were analyzed. The average measurement absolute abduction differences (postoperative CT-navigation record) were 3.9 ± 3.5° (severe DDH) and 3.3 ± 2.6° (non-DDH/ mild DDH), and the anteversion differences were 4.7 ± 3.4° (severe DDH) and 2.3 ± 2.1° (non-DDH/ mild DDH). The anteversion difference was different between the two groups. Multivariate analysis showed that the navigation difference (absolute difference in anteversion between postoperative CT and navigation records of > 5°) was significantly associated with severe DDH (odds ratio [OR]: 3.3; p = 0.049, 95% confidence interval [CI]: 1.0-11.1) and posterior pelvic tilt (OR: 1.1; p = 0.042, 95% CI: 1.0-1.27). In patients with severe DDH, it is important to pay close attention during THA using portable navigation. However, the average difference was < 5º even in patients with severe DDH, and the accuracy may be acceptable in a clinical setting when the cost is considered.

Ultrasound Assessment of Prevalence of ‘At Risk Stomach’ in Children Undergoing Elective Surgery- Prospective, Observational Study

Children may be at increased risk of pulmonary aspiration because of retention of gastric contents caused by pain or inadequate fasting. We performed this study to analyze the use of ultrasound for evaluation of gastric ultrasound in children less than 12 years. Two hundred children, 1-12 years of age belonging to ASA physical status I to II, scheduled to undergo elective surgery were included in the study. Patients were scanned in supine position followed by right lateral decubitus position (RLD). In qualitative assessment, the antrum was judged to contain fluid if it appeared to have an endocavitary lumen with hypoechoic content and distended walls. All measurements were taken with antrum at rest (between contraction) to avoid underestimating volume. It was observed that majority of the children were in Perlas grade 0, 116(58%) followed by 75 children in grade 1 and 9 children in grade 2. Using Karl Pearson’s Correlation coefficient, low positive correlation was found between gastric volume and fasting status solid (in hours) and the variation (correlation) was found to be statistically non-significant (r=0.139; p&gt;0.05). There is no proportionate decline in gastric volume with increased duration of preoperative fasting. Ultrasonographic measurement of antral area can be of interest to anesthesiologist for accurate qualitative and quantitative estimation of preoperative gastric contents and volume. However, gastric ultrasonography has to be validated in further trials involving a larger patient population before it can become a routine standard of care in perioperative period.

Comparative analysis of ultrasound-guided percutaneous biopsy of native kidneys in children and adults using the free-flank supine antero-lateral decubitus positioning.

Ultrasound-guided percutaneous biopsy (USPB) of the native kidneys is the preferred diagnostic method for several nephrological conditions in both adult and pediatric populations. Conventionally, native kidney biopsies are conducted with patients in the prone position (PP). However, an alternative approach involving the supine oblique antero-lateral position (SALP) has been explored, particularly for individuals who are obese, elderly, or critically ill. This study aimed to assess the feasibility and outcomes of USPB performed in SALP with a Free-Flank setting (FF-SALP) in pediatric patients (Group A) compared to adults (Group B). Data from kidney biopsies conducted between 2008 and 2021 were gathered. The study focused on the safety and the prevalence of biopsy samples containing a minimum of 10 glomeruli, histopathological yield in both groups. Complication rates were low in both groups (5.6% vs. 3.7%; p = 0.454), without major complications noted. The pediatric group achieved a significantly higher mean number of glomeruli per biopsy compared to the adult group (20.6 ± 12.3 vs. 15.7 ± 9.4; p < 0.001). However, when evaluating the minimum threshold of 10 glomeruli (76.3% vs. 68.5%; p = 0.072) and histopathologic yield (95.3% vs. 93.5%; p = 0.408), no differences were observed between groups. USPB of native kidneys in the FF-SALP position is a safe and effective method for tissue sampling in patients with parenchymal disease. It demonstrated comparable diagnostic yields and complication rates in the pediatric and adult populations, providing advantages in terms of airway management, making it particularly useful for pediatric patients that require general anesthesia.

Single Position Lateral versus Prone Transpsoas Lateral Interbody Fusion Inclusive of L4-L5: A Single Surgeon Experience Examining Early Postoperative Outcomes

The transpsoas lateral lumbar interbody fusion (LLIF) procedure is a minimally invasive lumbar spine approach that provides indirect neural decompression, improved sagittal alignment, and a high fusion rate. Typically accompanied by posterior pedicle screw insertion, there has been interest in performing LLIF in a single position to decrease cost and time under anesthesia. However, there is a paucity of direct comparisons between single-position LLIF via prone versus lateral decubitus positioning. Therefore, this stud aims to compare the outcomes of a single surgeon performing prone versus lateral single-position LLIF, inclusive of the L4-L5 level. A retrospective review was performed of a consecutive case series of patients who underwent either prone or lateral, single-position LLIF by a single surgeon All cases involved the L4-L5 level. Demographic data, perioperative details, clinical outcomes, and pre- and postoperative lumbar lordosis were recorded. 63 patients underwent lateral, and 16 patients underwent prone single-position LLIF. Demographics and average interbody size were similar between groups. Operative time, change in lumbar lordosis, and length of hospital stay did not differ between the two positions. Both groups performed similarly in terms of pre- and postoperative VAS pain score, and complications. Patients who underwent lateral position LLIF ambulated farther on postoperative day 1 (250 vs. 200 feet, p=0.015). Average time to follow up was 53 weeks. This study demonstrates promising preliminary results indicating that single-position LLIF performs well, even at the L4-L5 level, in both the prone and lateral positions.

The Effect of Intraoperative Patient Positioning on the Success of Intertrochanteric Fracture Surgery in Older Patients.

Background and Objectives: The incidence of hip fractures in people of advanced ages is increasing due to our aging society. Patient positioning for the intertrochanteric fractures of the femur can be performed in various ways. The aim of this study is to clinically and radiologically compare the use of the supine hemilithotomy position, the lateral decubitus position, and the traction table when performing proximal femoral nail (PFN) surgery for femoral intertrochanteric fractures in the geriatric age group. Materials and Methods: A total of 170 elderly patients with femoral intertrochanteric fractures were included in this cross-sectional study. The patients were divided into three groups (the supine hemilithotomy group, the lateral decubitus group, and the fracture table group). For the postoperative period, complications, length of stay in the intensive care unit, and length of stay in hospital were examined, while in postoperative radiographs, tip-apex distances (TADs), collodiaphyseal angles (CDAs), and Cleveland-Bosworth quadrants were examined to evaluate the placement of the lag screw in the femoral head. The quality of fracture reduction was evaluated according to the modified Baumgaertner criteria. Results: The mean age of the patients was 77.8 ± 8.8; 57.6% of patients were female. According to the modified Baumgaertner criteria, it was determined that patients with 'poor' reduction quality had an approximately ten times higher risk of cut-out than those with 'good' reduction quality (OR = 10.111, p = 0.002, 95% confidence interval; 2.313-44.207). The operative time for patients in the fracture table group was longer than that of the other groups Additionally, the CDA in the supine hemilithotomy position group was longer. Conclusions: Although PFN surgery using the traction table is longer in terms of surgical time compared to surgery performed in the lateral decubitus position and the supine hemilitotomy position, it is advantageous in terms of better TAD and CDA values and lower complication rates.

Endoscopic Posterior Cervical Foraminotomy Under Lateral Decubitus Position with Local Anesthesia

Endoscopic posterior cervical foraminotomy is gaining popularity among endoscopic spine surgeons for the treatment of radiculopathy caused by foraminal stenosis. This study describes a technique utilizing lateral decubitus position for an endoscopic posterior cervical foraminotomy under Monitored Anesthesia Care (MAC) and local anesthesia only. 10 patients with contraindications to general anesthesia underwent the procedure, resulting in an improvement in cervical radicular pain with no perioperative complications. The findings suggest that this approach is a viable alternative for high-risk patients for general anesthesia care, expanding the surgical options for the treatment of radiculopathy.

Effect of blind versus fluoroscopic guidance epidural blood patch in patients with intracranial hypotension

Epidural blood patch (EBP)—the most effective treatment for intracranial hypotension (IH)—can be performed using the blind technique in the lateral position or under fluoroscopic guidance in the prone position. This study aimed to compare the effectiveness of EBP in patients with spontaneous intracranial hypotension (sIH) and iatrogenic intracranial hypotension (iIH) when performed with the blind technique in the lateral decubitus position or fluoroscopic guidance in the prone position. We reviewed IH patients who underwent EBP between January 2015 and September 2019 in a single hospital and divided them into two groups according to the type of IH. Of the 84 included patients, 36 had sIH and 48 had iIH. We compared the effectiveness of EBP using the two methods in each group. There was no significant difference in the effect of EBP between the patients with iIH (p > 0.05). For patients with sIH, fluoroscopic guidance in the prone position technique showed better improvement than the blind technique in the lateral decubitus position (p < 0.05). We observed similar outcomes after blind EBP versus fluoroscopic guidance EBP in patients with iIH. However, procedure-dependent differences were observed in patients with sIH. For patients with sIH, it would be effective to consider fluoroscopic EBP first. Further study is needed to investigate interactions between method of EBP and other factors that affect the effectiveness of EBP.