Lumbar Puncture in the prone position for Low Birth Weight Neonates

Background Lumbar puncture in the lateral decubitus position will make the neonates uncomfortable and is likely to cause position change and unstable vital signs, and the application of sedative drugs will cause adverse effects. This study explored a novel method for lumbar puncture in the prone position for low weight neonates. Methods The neonates were randomly assigned into the standard position group receiving lumbar puncture in the lateral decubitus position; and the improved position group receiving lumbar puncture in the prone position. The success rate of first time attempts and the overall success rate of lumbar puncture, incidence of adverse effects, NIAPAS scores were collected and compared between these two groups. The difference in success rate and adverse effects incidence rate was analysed through Chi-square. Student’s t-test was used for the test of NIAPAS rating. Results The improved position group had a higher success rate of first attempt and overall success rate, significantly lower incidence of adverse effect and lower NIAPAS scores than those of the standard position group (P<0.05). Conclusion This lumbar puncture in the prone position is safer, more effective, and more comfortable for preterm neonates and those with low birth weight. Thus, this method is worth of further promotion. Trial registration Registration number, ChiCTR2100049923; Date of Registration, August 11, 2021; Retrospectively registered.

The impact of the lateral decubitus position in the perioperative period on posterior fixation for thoracolumbar fracture with ankylosing spinal disorder

OBJECTIVE Patients with ankylosing spinal disorders (ASDs), such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, often have rigid kyphosis of the spine. The fracture site is sometimes unintentionally displaced when surgery is conducted with the patient prone. To prevent this incident, the authors adopted the lateral decubitus position for patients intraoperatively for this pathology. The aim of this study was to retrospectively assess the impact of the lateral decubitus position in the perioperative period on posterior fixation for thoracolumbar fractures with ASD. METHODS Thirty-seven consecutive patients who underwent posterior instrumentation for thoracolumbar fracture with ASD at the authors’ institute were divided into 15 lateral decubitus positions (group L) and 22 prone positions (group P). Surgical time, estimated blood loss (EBL), number of levels fused, perioperative complications, length of stay (LOS), ratio of fracture voids, and ratio of anterior wall height were investigated. The ratio of fracture void and the ratio of anterior wall height were the radiological assessments showing a degree of reduction in vertebral fracture on CT. RESULTS Age, sex, BMI, fracture level, and LOS were similar between the groups. Levels fused and EBL were significantly shorter and less in group L (p < 0.001 and p = 0.04), but there was no significant difference in surgical time. The complication rate was similar, but 1 death within 90 days after surgery was found in group P. The ratio of fracture voids was 85.4% ± 12.8% for group L and 117.5% ± 37.3% for group P. A significantly larger number of patients with a fracture void ratio of 100% or less was found in group L (86.7% vs 36.4%, p = 0.002). The ratio of anterior wall height was 107.5% ± 12.3% for group L and 116.9% ± 18.8% for group P. A significantly larger number of patients with the anterior wall height ratio of 100% or less was also found in group L (60.0% vs 27.3%, p = 0.046). CONCLUSIONS The results of this study suggest that the lateral decubitus position can be expected to have an effect on closing or maintaining the fracture void or a preventive effect of intraoperative unintentional extension displacement of the fractured site, which is often seen in the prone position during surgery for thoracolumbar fractures involving ASD.

Location of the Femoral Nerve in the Lateral Decubitus Versus Prone Position

Study Design Cadaveric study. Objective To compare the position of the femoral nerve within the lumbar plexus at the L4-L5 disc space in the lateral decubitus vs prone position. Methods Seven lumbar plexus specimens were dissected and the femoral nerve within the psoas muscle was identified and marked with radiopaque paint. Lateral fluoroscopic images of the cadaveric specimens in the lateral decubitus vs prone position were obtained. The location of the radiopaque femoral nerve at the L4-L5 disc space was normalized as a percentage of the L5 vertebral body (0% indicates posterior location and 100% indicates anterior location at the L4-L5 disc space). The location of the femoral nerve at L4-L5 in the lateral decubitus vs prone position was compared using a paired t test. Results In the lateral decubitus position, the femoral nerve was located 28% anteriorly from the posterior edge of the L4-L5 disc space, and in the prone position, the femoral nerve was relatively more posterior, located 18% from the posterior edge of the L4-L5 disc space ( P = .037). Conclusions The femoral nerve was on average more posteriorly located at the L4-L5 disc space in the prone position compared to lateral decubitus. This more posterior location allows for a larger safe zone at the L4-L5 disc space, which may decrease the incidence of neurologic complications associated with Lateral lumbar interbody fusion in the prone vs lateral decubitus position; however, further studies are needed to evaluate this possible clinical correlation.

Clinical evaluation of diaphyseal femoral fractures operated in lateral decubitus position with interlocking nail

<p class="abstract"><strong>Background:</strong> The diaphyseal fractures of femur in adults are conventionally treated in supine position on traction table, which carries risk of compartment syndrome, pudendal nerve palsy, whereas in lateral decubitus position these complications can be avoided with additional advantage of easy access to greater trochanter particularly in obese patients. The aim of this study is to evaluate outcomes of femur diaphyseal fractures treated with intramedullary interlocking nail in lateral decubitus position.</p><p class="abstract"><strong>Methods:</strong> In this study 40 patients with femur diaphysea fractures were treated with intramedullary interlocking nail in lateral decubitus position, were studied for a period of 9 months from September 2019 to May 2020.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of our study of 40 patients, outcome is graded according Thoresen’s criteria where 22 (55%) patients had excellent results with full, pain-free, function of the extremity and 11 (27.5%) patients had good result; 10 patients had range of motion 120⁰ and shortening of femur by 1.5 was observed in 1 patient. There were 6 (15%) patients with fair result; with range of motion 90⁰ and 1 poor result (2.5%) had non-union with range of motion &lt;90⁰.</p><p class="abstract"><strong>Conclusions:</strong> Fixation of femur diaphyseal fracture in lateral decubitus position leads to easy access to the proximal femur making it easy to establish an entry point for an intramedullary device and it significantly eliminates the complications caused by other conventionally used methods.</p>