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Published on: July 25, 2025
[Application of adjustable oblique position for microendoscopic discectomy]
Huan Wang1, Xue-yong Liu, Lei Li
1Department of Orthopaedic Surgery, the Second Affiliated Hospital, China Medical University, Shenyang 110004, China. spinewh@sohu.com
Objective:
To compare the adjustable oblique position with prone position in microendoscopic discectomy (MED) and to evaluate its advantages.
Methods:
One hundred and twenty-eight patients who underwent MED during August 2000 and August 2002 were studied. Forty-seven cases were positioned prone, 81 cases were positioned with adjustable oblique position. Operating time, blood loss and patient endurance were recorded and compared. The airway resistance of 29 lumbar disorder patients was measured when they were positioned supine, lateral and prone respectively after general anesthesia.
Results:
There was statistically significant difference between 2 groups in operating time, blood loss and endurance. In prone position group, when operating time lasted for more than 50 min, 75% patients felt hurt on the skin of rib arch, and 38% patients presented dizzy and nausea. And all the patients had erythema on the rib arch. In the adjustable oblique position group, 3 cases had shoulder pain after operation, and 1 case had 4 days' common poroneal nerve paralysis. The airway resistance of patients with prone position was significantly higher than those with supine and lateral positioned patients. (P < 0.05).
Conclusion:
The adjustable oblique position in MED had the following advantages: (1) Do not limit the movement of chest and help reduce intra-abdominal pressure and epidural bleeding; (2) Give the lumbar spine the largest degree of flexion and the largest interlaminar space, which prevents injury of facet joint; (3) Increase posterior intervertebral space and make disectomy easier and exposure of nerve root and nerve root canal clearer; (4) The patients feel comfortable and can adjust the position of lumbar spine and lower extremity; (5) The monitor has the same direction with doctor, and it is easy for the doctor to operate; (6) Doctor can sit during operation.
Insights
The adjustable oblique position in microendoscopic discectomy (MED) offers better patient endurance and reduced operating time compared to the prone position. This technique also minimizes airway resistance, improving patient outcomes.
Area of Science:
- Neurosurgery
- Minimally Invasive Spine Surgery
- Surgical Positioning
Background:
- Microendoscopic discectomy (MED) is a minimally invasive technique for treating lumbar disc herniation.
- Patient positioning is crucial for surgical success and patient comfort during MED.
- Traditional prone positioning may lead to complications such as increased airway resistance and patient discomfort.
Purpose of the Study:
- To compare the efficacy and safety of the adjustable oblique position versus the prone position in microendoscopic discectomy (MED).
- To evaluate the advantages of the adjustable oblique position in MED procedures.
Main Methods:
- A comparative study of 128 patients undergoing MED between August 2000 and August 2002.
- Patients were divided into two groups: 47 in prone position and 81 in adjustable oblique position.
- Key metrics recorded included operating time, blood loss, patient endurance, and airway resistance.
Main Results:
- The adjustable oblique position group demonstrated statistically significant improvements in operating time, blood loss, and patient endurance compared to the prone group.
- Prone positioning was associated with higher rates of patient discomfort (rib arch pain, dizziness, nausea) and increased airway resistance.
- The adjustable oblique position resulted in fewer complications, primarily minor shoulder pain or temporary peroneal nerve issues.
Conclusions:
- The adjustable oblique position offers significant advantages for MED, including reduced intra-abdominal pressure and epidural bleeding.
- This position facilitates greater lumbar flexion, increases interlaminar and posterior intervertebral space, and improves visualization of neural structures.
- Enhanced patient comfort, surgeon ergonomics (ability to sit), and improved operative conditions make the adjustable oblique position a superior choice for MED.