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The anatomical positioning change of retroperitoneal organs in prone and lateral position: an assessment for single-prone position lateral lumbar surgery

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Abstract

Purpose

There are reports that performing lateral lumbar interbody fusion (LLIF) in a prone, single position (single-prone LLIF) can be done safely in the prone position because the retroperitoneal organs reflect anteriorly with gravity. However, only a few study has investigated the safety of single-prone LLIF and retroperitoneal organ positioning in the prone position. We aimed to investigate the positioning of retroperitoneal organs in the prone position and evaluate the safety of single-prone LLIF surgery.

Methods

A total of 94 patients were retrospectively reviewed. The anatomical positioning of the retroperitoneal organs was evaluated by CT in the preoperative supine and intraoperative prone position. The distances from the centre line of the intervertebral body to the organs including aorta, inferior vena cava, ascending and descending colons, and bilateral kidneys were measured for the lumbar spine. An “at risk” zone was defined as distance less than 10 mm anterior from the centre line of the intervertebral body.

Results

Compared to supine preoperative CTs, bilateral kidneys at the L2/3 level as well as the bilateral colons at the L3/4 level had statistically significant ventral shift with prone positioning. The proportion of retroperitoneal organs within the at-risk zone ranged from 29.6 to 88.6% in the prone position.

Conclusions

The retroperitoneal organs shifted ventrally with prone positioning. However, the amount of shift was not large enough to avoid risk for organ injuries and substantial proportion of patients had organs within the cage insertion corridor. Careful preoperative planning is warranted when considering single-prone LLIF.

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Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Dr. Sama reports royalties from Ortho Development, Corp.; private investments for Vestia Ventures MiRUS Investment, LLC, ISPH II, LLC, ISPH 3, LLC, and VBros Venture Partners X Centinel Spine; consulting fee from Clariance, Inc., Kuros Biosciences AG, and Medical Device Business Service, Inc.; speaking and teaching arrangements of DePuy Synthes Products, Inc.; membership of scientific advisory board of Clariance, Inc., and Kuros Biosciences AG; and trips/travel of Medical Device Business research support from Spinal Kinetics, Inc., outside the submitted work. Dr. Cammisa reports royalties from NuVasive, Inc.; private investments for 4WEB Medical/4WEB, Inc., Bonovo Orthopedics, Inc., Healthpoint Capital Partners, LP, ISPH II, LLC, ISPH 3 Holdings, LLC, Ivy Healthcare Capital Partners, LLC, Medical Device Partners II, LLC, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, Tissue Differentiation Intelligence, LLC, VBVP VI, LLC, VBVP X, LLC (Centinel) and Woven Orthopedics Technologies; consulting fees from 4WEB Medical/4WEB, Inc., DePuy Synthes Spine, NuVasive, Inc., Spine Biopharma, LLC, and Synexis, LLC; membership of scientific advisory board/other office of Healthpoint Capital Partners, LP, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, and Woven Orthopedic Technologies; and research support from 4WEB Medical/4WEB, Inc., Mallinckrodt Pharmaceuticals, Camber Spine, and Centinel Spine, outside the submitted work. Dr. Girardi reports royalties from Lanx, Inc., and Ortho Development Corp.; private investments for Centinel Spine, and BCMID; stock ownership of Healthpoint Capital Partners, LP; and consulting fees from NuVasive, Inc., and DePuy Synthes Spine, outside the submitted work. Dr. Hughes reports research support from NuVasive, Inc. and Kuros Biosciences AG; and fellowship support from NuVasive, Inc. and Kuros Biosciences AG, outside the submitted work. Dr.Lebl reports royalties from NuVasive, Inc and Stryker; private investments from HS2, LLC, Woven Orthopedic Technologies, Vestia Ventures MiRus Investiment LLC, ISPH, LLC; consulting fee from Depuy Synthes, Vizeon, Inc; scientific advisory board from Remedy Logic; and research support from Medtronic.

Funding

There was no financial support for this research reported in this publication.

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Authors and Affiliations

  1. Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA

    Yusuke Dodo, Henryk Haffer, Maximilian Muellner, Erika Chiapparelli, Jennifer Shue, Darren R. Lebl, Frank P. Cammisa, Federico P. Girardi, Alexander P. Hughes, Gbolabo Sokunbi & Andrew A. Sama

  2. Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan

    Yusuke Dodo & Ichiro Okano

  3. Weill Cornell Medicine, New York, NY, USA

    Neil A. Kelly

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  1. Yusuke Dodo
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  13. Andrew A. Sama
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yusuke Dodo, Ichiro Okano, Neil A.Kelly, Henryk Haffer, Maximilian Muellner, Jennifer Shue and Andrew A.Sama. The first draft of the manuscript was written by Yusuke Dodo, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Andrew A. Sama.

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Conflict of interest

The authors declare that there is no conflict of interest concerning materials or methods used in this study or the findings specified in this paper.

Ethical approval

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and approved by the institutional review board of Hospital for Special Surgery (HSS-IRB #2021-–1506). Written informed consent was waived.

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The work was performed at Hospital for Special Surgery, New York City, NY, USA. The institutional review board of Hospital for Special Surgery approved this study.

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Dodo, Y., Okano, I., Kelly, N.A. et al. The anatomical positioning change of retroperitoneal organs in prone and lateral position: an assessment for single-prone position lateral lumbar surgery. Eur Spine J 32, 2003–2011 (2023). https://doi.org/10.1007/s00586-023-07738-w

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