Increasing lumbar lordosis of adult spinal deformity patients via intraoperative prone positioning

Katsumi Harimaya, Lawrence G. Lenke, Takuya Mishiro, Keith H. Bridwell, Linda A. Koester, Brenda A. Sides

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Study Design. A retrospective evaluation. Objective. To evaluate the change in lumbar lordosis in spinal deformity patients who underwent an instrumented posterior spinal fusion on the Orthopedic Systems Inc. (OSI) "Jackson" frame. Summary of Background Data. Intraoperative prone positioning with hip extension may posturally increase lumbar lordosis during adult spinal deformity reconstructive surgery, as has been shown in adult lumbar degenerative surgery. Methods. Radiographs of 44 operative spinal deformity patients (43 females/1 male; mean age, 57.4 years) were analyzed. Diagnoses included idiopathic scoliosis (29), degenerative lumbar scoliosis (9), and other (6). Total lumbar lordosis (T12-S1), segmental disc angles, and C7 plumbline were measured on preoperative upright and supine, intraoperative prone, and postoperative upright lateral radiographs. All patients were positioned intraoperatively with hip extension on the OSI frame. Results. Average preoperative upright and supine, intraoperative prone, and postoperative upright lumbar lordosis (T12-SAC) measurements were -38.1°, -46.0°, -46.2°, and -51.8°, respectively (P < 0.05 for preoperative upright to all other comparisons). Two groups were noted: those with increased lumbar lordosis (>5°) during intraoperative prone positioning (n = 25, increased lordosis group) as compared to the preoperative measurement versus those with minimal to no change in lordosis (≤5°) during intraoperative prone positioning (n = 19, unchanged lordosis group). The corresponding lumbar lordosis measurements for the increased lordosis group were -25.9°, -40.0°, -43.1°, and -48.9° (P < 0.05 for preoperative upright to all other comparisons). The corresponding lumbar lordosis measurements for the unchanged lordosis group were -54.2°, -53.8°, -50.3°, and -55.7° (no significant differences). Preoperative upright lumbar lordosis in the unchanged lordosis group was substantially higher than increased lumbar lordosis group (P < 0.05). Conclusion. Adult spinal deformity patients with preoperative hypolordosis who were positioned prone during reconstructive surgery had an enhanced lumbar lordosis via positioning alone compared with theirpreoperative upright radiographs. Conversely, those with substantial preoperative lordosis remained unchanged with intraoperative prone positioning. This knowledge will help in the surgical planning of adult spinal deformity reconstructive surgery to optimize sagittal alignment and balance.

Original languageEnglish
Pages (from-to)2406-2412
Number of pages7
JournalSpine
Volume34
Issue number22
DOIs
Publication statusPublished - Oct 15 2009
Externally publishedYes

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Lordosis
Reconstructive Surgical Procedures
Scoliosis
Orthopedics
Hip
Spinal Fusion

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Harimaya, K., Lenke, L. G., Mishiro, T., Bridwell, K. H., Koester, L. A., & Sides, B. A. (2009). Increasing lumbar lordosis of adult spinal deformity patients via intraoperative prone positioning. Spine, 34(22), 2406-2412. https://doi.org/10.1097/BRS.0b013e3181bab13b

Increasing lumbar lordosis of adult spinal deformity patients via intraoperative prone positioning. / Harimaya, Katsumi; Lenke, Lawrence G.; Mishiro, Takuya; Bridwell, Keith H.; Koester, Linda A.; Sides, Brenda A.

In: Spine, Vol. 34, No. 22, 15.10.2009, p. 2406-2412.

Research output: Contribution to journalArticle

Harimaya, K, Lenke, LG, Mishiro, T, Bridwell, KH, Koester, LA & Sides, BA 2009, 'Increasing lumbar lordosis of adult spinal deformity patients via intraoperative prone positioning', Spine, vol. 34, no. 22, pp. 2406-2412. https://doi.org/10.1097/BRS.0b013e3181bab13b
Harimaya, Katsumi ; Lenke, Lawrence G. ; Mishiro, Takuya ; Bridwell, Keith H. ; Koester, Linda A. ; Sides, Brenda A. / Increasing lumbar lordosis of adult spinal deformity patients via intraoperative prone positioning. In: Spine. 2009 ; Vol. 34, No. 22. pp. 2406-2412.
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abstract = "Study Design. A retrospective evaluation. Objective. To evaluate the change in lumbar lordosis in spinal deformity patients who underwent an instrumented posterior spinal fusion on the Orthopedic Systems Inc. (OSI) {"}Jackson{"} frame. Summary of Background Data. Intraoperative prone positioning with hip extension may posturally increase lumbar lordosis during adult spinal deformity reconstructive surgery, as has been shown in adult lumbar degenerative surgery. Methods. Radiographs of 44 operative spinal deformity patients (43 females/1 male; mean age, 57.4 years) were analyzed. Diagnoses included idiopathic scoliosis (29), degenerative lumbar scoliosis (9), and other (6). Total lumbar lordosis (T12-S1), segmental disc angles, and C7 plumbline were measured on preoperative upright and supine, intraoperative prone, and postoperative upright lateral radiographs. All patients were positioned intraoperatively with hip extension on the OSI frame. Results. Average preoperative upright and supine, intraoperative prone, and postoperative upright lumbar lordosis (T12-SAC) measurements were -38.1°, -46.0°, -46.2°, and -51.8°, respectively (P < 0.05 for preoperative upright to all other comparisons). Two groups were noted: those with increased lumbar lordosis (>5°) during intraoperative prone positioning (n = 25, increased lordosis group) as compared to the preoperative measurement versus those with minimal to no change in lordosis (≤5°) during intraoperative prone positioning (n = 19, unchanged lordosis group). The corresponding lumbar lordosis measurements for the increased lordosis group were -25.9°, -40.0°, -43.1°, and -48.9° (P < 0.05 for preoperative upright to all other comparisons). The corresponding lumbar lordosis measurements for the unchanged lordosis group were -54.2°, -53.8°, -50.3°, and -55.7° (no significant differences). Preoperative upright lumbar lordosis in the unchanged lordosis group was substantially higher than increased lumbar lordosis group (P < 0.05). Conclusion. Adult spinal deformity patients with preoperative hypolordosis who were positioned prone during reconstructive surgery had an enhanced lumbar lordosis via positioning alone compared with theirpreoperative upright radiographs. Conversely, those with substantial preoperative lordosis remained unchanged with intraoperative prone positioning. This knowledge will help in the surgical planning of adult spinal deformity reconstructive surgery to optimize sagittal alignment and balance.",
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AU - Lenke, Lawrence G.

AU - Mishiro, Takuya

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AU - Koester, Linda A.

AU - Sides, Brenda A.

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N2 - Study Design. A retrospective evaluation. Objective. To evaluate the change in lumbar lordosis in spinal deformity patients who underwent an instrumented posterior spinal fusion on the Orthopedic Systems Inc. (OSI) "Jackson" frame. Summary of Background Data. Intraoperative prone positioning with hip extension may posturally increase lumbar lordosis during adult spinal deformity reconstructive surgery, as has been shown in adult lumbar degenerative surgery. Methods. Radiographs of 44 operative spinal deformity patients (43 females/1 male; mean age, 57.4 years) were analyzed. Diagnoses included idiopathic scoliosis (29), degenerative lumbar scoliosis (9), and other (6). Total lumbar lordosis (T12-S1), segmental disc angles, and C7 plumbline were measured on preoperative upright and supine, intraoperative prone, and postoperative upright lateral radiographs. All patients were positioned intraoperatively with hip extension on the OSI frame. Results. Average preoperative upright and supine, intraoperative prone, and postoperative upright lumbar lordosis (T12-SAC) measurements were -38.1°, -46.0°, -46.2°, and -51.8°, respectively (P < 0.05 for preoperative upright to all other comparisons). Two groups were noted: those with increased lumbar lordosis (>5°) during intraoperative prone positioning (n = 25, increased lordosis group) as compared to the preoperative measurement versus those with minimal to no change in lordosis (≤5°) during intraoperative prone positioning (n = 19, unchanged lordosis group). The corresponding lumbar lordosis measurements for the increased lordosis group were -25.9°, -40.0°, -43.1°, and -48.9° (P < 0.05 for preoperative upright to all other comparisons). The corresponding lumbar lordosis measurements for the unchanged lordosis group were -54.2°, -53.8°, -50.3°, and -55.7° (no significant differences). Preoperative upright lumbar lordosis in the unchanged lordosis group was substantially higher than increased lumbar lordosis group (P < 0.05). Conclusion. Adult spinal deformity patients with preoperative hypolordosis who were positioned prone during reconstructive surgery had an enhanced lumbar lordosis via positioning alone compared with theirpreoperative upright radiographs. Conversely, those with substantial preoperative lordosis remained unchanged with intraoperative prone positioning. This knowledge will help in the surgical planning of adult spinal deformity reconstructive surgery to optimize sagittal alignment and balance.

AB - Study Design. A retrospective evaluation. Objective. To evaluate the change in lumbar lordosis in spinal deformity patients who underwent an instrumented posterior spinal fusion on the Orthopedic Systems Inc. (OSI) "Jackson" frame. Summary of Background Data. Intraoperative prone positioning with hip extension may posturally increase lumbar lordosis during adult spinal deformity reconstructive surgery, as has been shown in adult lumbar degenerative surgery. Methods. Radiographs of 44 operative spinal deformity patients (43 females/1 male; mean age, 57.4 years) were analyzed. Diagnoses included idiopathic scoliosis (29), degenerative lumbar scoliosis (9), and other (6). Total lumbar lordosis (T12-S1), segmental disc angles, and C7 plumbline were measured on preoperative upright and supine, intraoperative prone, and postoperative upright lateral radiographs. All patients were positioned intraoperatively with hip extension on the OSI frame. Results. Average preoperative upright and supine, intraoperative prone, and postoperative upright lumbar lordosis (T12-SAC) measurements were -38.1°, -46.0°, -46.2°, and -51.8°, respectively (P < 0.05 for preoperative upright to all other comparisons). Two groups were noted: those with increased lumbar lordosis (>5°) during intraoperative prone positioning (n = 25, increased lordosis group) as compared to the preoperative measurement versus those with minimal to no change in lordosis (≤5°) during intraoperative prone positioning (n = 19, unchanged lordosis group). The corresponding lumbar lordosis measurements for the increased lordosis group were -25.9°, -40.0°, -43.1°, and -48.9° (P < 0.05 for preoperative upright to all other comparisons). The corresponding lumbar lordosis measurements for the unchanged lordosis group were -54.2°, -53.8°, -50.3°, and -55.7° (no significant differences). Preoperative upright lumbar lordosis in the unchanged lordosis group was substantially higher than increased lumbar lordosis group (P < 0.05). Conclusion. Adult spinal deformity patients with preoperative hypolordosis who were positioned prone during reconstructive surgery had an enhanced lumbar lordosis via positioning alone compared with theirpreoperative upright radiographs. Conversely, those with substantial preoperative lordosis remained unchanged with intraoperative prone positioning. This knowledge will help in the surgical planning of adult spinal deformity reconstructive surgery to optimize sagittal alignment and balance.

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