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Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique
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Great Vessel Excursion: Prone Versus Supine Position.

Alexander R Riccio1, Andrew Bishop1, Allen L Carl1

  • 1Department of Neurosurgery, Albany Medical Center, Albany, New York.

International Journal of Spine Surgery
|May 28, 2019
PubMed
Summary
This summary is machine-generated.

Placing pedicle screws into the anterior vertebral cortex may increase strength but poses risks. Prone positioning, contrary to hypothesis, moves the aorta closer to the screw path in the thoracic spine, increasing vascular injury risk.

Keywords:
bicorticalgreat vesselpedicle screwspine

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Area of Science:

  • Spinal surgery
  • Anatomy
  • Biomechanics

Background:

  • Pedicle screw fixation aims to enhance spinal biomechanical strength.
  • Anterior cortical placement is theorized to improve fixation by 20-25%.
  • Vessel proximity to screw trajectory during prone positioning is not well-documented.

Purpose of the Study:

  • To evaluate the positional changes of great vessels relative to the anterior vertebral cortex in supine versus prone positions.
  • To assess the safety margin for pedicle screw placement from a posterior approach.

Main Methods:

  • MRI scans of 20 healthy volunteers in supine and prone positions.
  • Measurement of distances from projected pedicle screw tips to great vessels at T3-L5.
  • Analysis of vessel alignment with screw trajectory in both positions.

Main Results:

  • Great vessels are 2-10 mm from the anterior cortex.
  • In the thoracic spine, the aorta moves anteriorly (1.4-5 mm) when prone, nearing the screw path.
  • The inferior vena cava translates 1.7-2.9 mm in the thoracolumbar region.

Conclusions:

  • Prone positioning increases the risk of vascular injury during posterior pedicle screw placement targeting the anterior cortex.
  • Great vessels remain close to vertebrae in lumbar, upper thoracic, and thoracolumbar regions.
  • The aorta's anterior shift in the mid-thoracic spine creates a riskier screw trajectory.