To rotate or not to rotate? - that is the question

​​To rotate or not to rotate? – that is the question

Our 2nd paper was accepted as an E-presentation at SMISS 2022. This E-Presentation is Titled: Reproducibility of Implant Positioning During Prone Lateral Interbody Fusion (LIF): Does Bed Rotation Result in Increased Variability of Interbody Placement?

Take Away Points:

1. Keeping a good line of sight down the transpsoas corridor is essential during a prone LLIF. This can put the surgeon’s neck in an uncomfortable position when the patient and retractor are in the perfectly orthogonal position. Working in an uncomfortable position is not ideal. Proper surgical ergonomics is vital for surgeon experience and longevity!

2. To restore ergonomics to the approach, our team implemented mild bed rotation. This consisted of the surgeon preparing for a prone LLIF in the orthogonal manner with retractor handles perfectly vertical. Prior to disc work, the surgeon sat and then rotated the bed approximately 5-10 degs away until line of sight was optimized (see video in next post). The new reference angle during disc preparation would be the 90deg angle between the instruments and the retractor handles. An ALL retractor and posterior shim were placed during all surgeries to maintain a safe anterior and posterior margin and a safe working corridor.

3. It may be ideal for surgeons to keep the patient at 0degs, so their reference angle for disc prep is parallel to the ceiling and floor. Especially early in their learning curve. Nevertheless, our team has noted that slight bed rotation can improve visualization without compromising implant variability when following specific steps to set up a referencing angle, even in the very rotated spine (see case example)  

4. When introducing bed rotation, it’s beneficial to ask your medical device rep to stand at the foot of the bed and keep a close eye on the 90deg angle between your instruments and retractor handles. Medical device reps can play an important role if carefully integrated into the team. (see next post for video)

Whatever position you are comfortable with is exactly what you should use!

Michael Rogers Jahangir ‘John’ Asghar, MD Alfredo Guiroy

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