Spine deformity · 2026
Changes in retroperitoneal anatomy of the lumbar spine in supine, prone, and lateral lumbar spine MRIs.
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Pompa-Hogan Briana M, Mason Gabriel B, Fisher Miles W A, Homeier Daniel D, Mills Gavin L, Yerich Nadiya V, Aden James K, Hurley Richard K
Аннотация
PURPOSE: To investigate the changes in anatomy of the retroperitoneal (RP) space and lumbar lordosis based on magnetic resonance imaging (MRI) acquired in different positions.
METHODS: Twelve adults underwent MRI in the right-lateral decubitus, prone, and supine positions. At each lumbar disc space, the cross-sectional area (CSA) of the psoas, RP space CSA, distance to the great vessels, and lumbar lordosis were measured.
RESULTS: At L2-3, the CSA of the RP space was increased in the lateral position compared to the prone position (11.4cm2 vs 7.5cm2, P=0.0071), and at L3-4 the RP space was significantly smaller in the lateral position compared to the supine position (6.9mm2 vs 10.3mm2, P=0.0157). When stratified by sex, males had a larger left RP space in the lateral position at L2/3 (18.7 cm2) compared to prone (11.9 cm2, P=0.0042) and supine (13.0 cm2, P=0.0148). Females had a larger RP in the supine position at L2/3 (5.4 cm2) compared to prone (3.1 cm2, P=0.008), supine L3/4 (5.4cm2) compared to lateral L3/4 (2.9 cm2, P=0.0046) and supine L4/5 (13.4 cm2) compared to prone L4/5 (11.0cm2, P=0.0049) and lateral L4/5 (8.7cm2, P<0.0001). In the lateral decubitus position, there was a lower lumbar lordosis when compared to the two other positions (P<0.05).
CONCLUSION: This study found that the size of the RP space varies depending on patient positioning and sex, while also demonstrating a flattening effect as RP CSA decreased at L3/4 in the lateral position. A nuanced understanding of the RP anatomy may influence a surgeon's decision-making regarding intraoperative patient positioning to exploit safe operative corridors.
METHODS: Twelve adults underwent MRI in the right-lateral decubitus, prone, and supine positions. At each lumbar disc space, the cross-sectional area (CSA) of the psoas, RP space CSA, distance to the great vessels, and lumbar lordosis were measured.
RESULTS: At L2-3, the CSA of the RP space was increased in the lateral position compared to the prone position (11.4cm2 vs 7.5cm2, P=0.0071), and at L3-4 the RP space was significantly smaller in the lateral position compared to the supine position (6.9mm2 vs 10.3mm2, P=0.0157). When stratified by sex, males had a larger left RP space in the lateral position at L2/3 (18.7 cm2) compared to prone (11.9 cm2, P=0.0042) and supine (13.0 cm2, P=0.0148). Females had a larger RP in the supine position at L2/3 (5.4 cm2) compared to prone (3.1 cm2, P=0.008), supine L3/4 (5.4cm2) compared to lateral L3/4 (2.9 cm2, P=0.0046) and supine L4/5 (13.4 cm2) compared to prone L4/5 (11.0cm2, P=0.0049) and lateral L4/5 (8.7cm2, P<0.0001). In the lateral decubitus position, there was a lower lumbar lordosis when compared to the two other positions (P<0.05).
CONCLUSION: This study found that the size of the RP space varies depending on patient positioning and sex, while also demonstrating a flattening effect as RP CSA decreased at L3/4 in the lateral position. A nuanced understanding of the RP anatomy may influence a surgeon's decision-making regarding intraoperative patient positioning to exploit safe operative corridors.