Lumbar spine deformation between prone and supine CTs

Area of Science:

• Spine surgery
• Medical imaging
• Orthopedic biomechanics

Background:

• Spinal navigation systems enhance pedicle screw accuracy.
• Supine preoperative imaging may not reflect intraoperative spinal alignment, potentially compromising surgical outcomes.
• Positional discrepancies are a critical concern in lumbar spine procedures.

Purpose of the Study:

• To investigate differences in key lumbar and lumbopelvic parameters between prone and supine positions.
• To refine imaging workflows and surgical navigation practices for lumbar spine surgery.
• To address the gap in understanding positional alignment variations for spinal navigation.

Main Methods:

• Retrospective cohort study analyzing paired prone and supine CT images from 85 adult patients.
• Measurement of key parameters: pelvic tilt, lumbar lordosis, L1 slope, pelvic incidence, and L1-L5 Cobb angle.
• Statistical analysis using two-tailed t-tests and pairwise comparisons to assess positional differences.

Main Results:

• Significant differences observed in pelvic tilt (mean difference: 4.27°, p=0.0002) and L1 slope (mean difference: 3.16°, p=0.001) between prone and supine positions.
• No significant differences found in lumbar lordosis, pelvic incidence, or L1-L5 Cobb angle.
• This study provides the first comprehensive analysis of prone vs. supine lumbar spine alignment.

Conclusions:

• Supine preoperative imaging has limitations in accurately representing intraoperative lumbar spine conditions.
• Integrating prone/supine alignment data into navigation workflows can improve registration accuracy and surgical outcomes.
• Advancing imaging protocols and exploring AI-based modeling are crucial for optimizing lumbar spine surgeries.