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Effects of Prone and Jackknife Positioning on Lumbar Disc Herniation Surgery

Akinci, Ibrahim Ozkan MD*; Tunali, Ugur MD*; Kyzy, Ainura Aidarbak MD*; Guresti, Ece MD*; Sencer, Altay MD; Karasu, Aykut MD; Telci, Lutfi MD*

Journal of Neurosurgical Anesthesiology: October 2011 - Volume 23 - Issue 4 - p 318–322
doi: 10.1097/ANA.0b013e31822b4f17
Clinical Investigations

Background: Intra-abdominal hypertension due to surgical position increases bleeding at the surgical site. In this study, we evaluated the impact of prone and jackknife position on intra-abdominal pressure (IAP), lung mechanics, blood loss at the surgical site, and duration of the surgical procedure on lumbar disc operations.

Methods: Forty patients operated for single-space lumber disc herniation were included in our study. All patients were ASA I-II and 18 to 70 years old. Patients who had undergone previous spinal surgery, were on anticoagulant or anti-aggregant therapy, had hypertension, cardiac, respiratory, liver, or renal disorders, and were obese (Body Mass Index >35 kg/m2) were excluded. Patients were randomly assigned to either the prone or the jackknife position for surgery. Differences in lung mechanics, IAP, and surgical-site blood loss were calculated in both patient groups. Changes in pulmonary and abdominal pressure levels were measured both in face-up and down positions.

Results: Bleeding at the surgical site (prone: 180.0±100.0 mL, jackknife: 100.0±63.6 mL, P=0.018) and IAP (prone: 11.0±3.0 mm Hg, jackknife: 8.0±2.0 mm Hg, P=0.006) were significantly reduced when patients were in the jackknife position. Operating time was approximately 40 minutes shorter in the jackknife position group, although this difference was not significant.

Conclusions: The jackknife position causes less IAP elevation and less surgical site bleeding compared with the prone position. The jackknife position is the preferred choice for single-level lumbar disc surgery in healthy, nonobese patients.

*Department of Anesthesiology and Intensive Care

Department of Neurosurgery, Istanbul Medical Faculty, Istanbul University, Capa Klinikleri, Capa, Istanbul, Turkey

The authors have no funding or conflicts of interest to disclose.

Reprints: Ibrahim Ozkan Akinci, MD, Department of Anesthesiology and Intensive Care, Istanbul Medical Faculty, Istanbul University, Capa Klinikleri, Mono Blok 34390, Capa, Istanbul, Turkey (e-mail:

Received February 22, 2011

Accepted June 27, 2011

© 2011 Lippincott Williams & Wilkins, Inc.