Comparison between the surgical outcomes of the lumbar microdiscectomy with
patients in prone and lateral positions
Assoc. Prof. Yavor Enchev, MD, PhD, MHA, FRCS(Eng), B. Iliev, MD, PhD, T. Kondev,
MD, Pl. Trendafilov, MD, Stephanie Todorova
Department of Neurosurgery, University Hospital “St. Marina”, Medical University of Varna,
Varna, Bulgaria
Background.
The patient positioning represents important part of every neurosurgical procedure.
The two most frequently used positions in lumbar microdiscectomy are lateral and prone. The
purpose of this study was to compare the clinical outcomes of patients operated on in lateral
and prone positions and the associated advantages and drawbacks.
Material and Methods.
During the period of 3 years (2012-2014) in the Department of Neurosurgery at
University Hospital “St. Marina”- Varna were performed 169 lumbar microdiscectomies. In
113 cases the patients were treated in lateral position and in the rest 56 cases in prone
position. Universal neurosurgical checklist examiner was applied routinely for prevention of
wrong site and wrong level surgery and complications due to incorrect positioning of the
patients.
Results.
In their series of 169 microdiscectomies, the authors have produced good-to-excellent
clinical results in nearly 96% of patients, with the majority returning to work within 1 month.
The complication rate of dural tears, discitis has been about 1%, with a reoperation rate of less
than 4% equally distributed between both positions. No events of wrong site and wrong level
surgery and complications due to incorrect positioning of the patients were found out.
Conclusion.
The different positioning of the patients for lumbar microdiscectomy does not
influence significantly the surgical outcomes. However, it is associated with different
potential complications due to eventual incorrect positioning of the patient. Both positions
have their advantages and shortcomings and the neurosurgeon must judge which the best
option for every individual case is.