[Spinal microsurgery at the thoracic to sacral level in the "prone-oblique" position]

Until the present time, almost all posterior approaches to the thoracic to sacral region have been made in either the knee-elbow or the prone position. Those positions, however, have potential disadvantages such as respiratory suppression and/or disturbance of venous return due to compression of the anterior chest and belly. In order to avoid the above mentioned disadvantages, the patient was laid on the operating table in a "Prone-Oblique" position, with the body rotating about 40 degrees around the long axis. The authors performed, with successful results, spinal operations via the posterior route in the "Prone-Oblique" position in 30 cases. An illustrative case was presented of a metastatic intramedullary tumor at the T11/12 level from an unresectable mammary cancer. The cancer had infiltrated and bulged out of the left anterior chest wall so severely and extensively that an operation in the conventional position was impossible. The metastatic tumor was totally and successfully removed via the posterior approach in the "Prone-Oblique" position without any complications related to the position. This "Prone-Oblique" position seems to be physiologically suitable, giving rise to no harmful compression of any part of the patient's body and it provides the surgeon a comfortable posture and a good operative view during microsurgery.