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Dodo Y, Okano I, Kelly NA, Haffer H, Muellner M, Chiapparelli E, Shue J, Lebl DR, Cammisa FP, Girardi FP, Hughes AP, Sokunbi G, Sama AA. The anatomical positioning change of retroperitoneal organs in prone and lateral position: an assessment for single-prone position lateral lumbar surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2003-2011. [PMID: 37140640 DOI: 10.1007/s00586-023-07738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/20/2023] [Accepted: 04/22/2023] [Indexed: 05/05/2023]
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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Affiliation(s)
- Yusuke Dodo
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | | | - Henryk Haffer
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA
| | - Maximilian Muellner
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA
| | - Erika Chiapparelli
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA
| | - Jennifer Shue
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA
| | - Darren R Lebl
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA
| | - Frank P Cammisa
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA
| | - Federico P Girardi
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA
| | - Alexander P Hughes
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA
| | - Gbolabo Sokunbi
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA
| | - Andrew A Sama
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th st., New York, NY, 10021, USA.
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Park SH, Kim DH. CT colonography interpretation: how to maximize polyp detection and minimize overcalling. Abdom Radiol (NY) 2018; 43:539-553. [PMID: 29404639 DOI: 10.1007/s00261-018-1455-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article outlines how to achieve maximum accuracy in interpreting CT colonography (CTC) regarding colonic findings. Interpreting extracolonic findings seen on CTC is a separate diagnostic task and will not be addressed in this article. While many interpretive pitfalls are in fact related to CTC techniques, this article focuses on issues that are related to interpretive knowledge and skills, avoiding in-depth discussions on CTC techniques. Principal methods and further tips for detecting possible polyp candidates and for confirming true soft-tissue polyps will be discussed. Specific points about optimizing interpretation strategies for difficult flat polyps including sessile serrated polyp will be raised. There are numerous interpretive pitfalls regarding the colonic interpretation of CTC. Knowledge of these pitfalls will shorten the learning curve and help achieve accurate reads.
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Affiliation(s)
- Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, E3/311, 600 Highland Ave, Madison, WI, 53792-3252, USA
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