The change in lumbar lordosis from the standing to the lateral position: implications for lateral interbody fusion

Purpose: The purpose of this cross-sectional, observational study was to establish the relationship between standing lumbar lordosis (LL) and lateral decubitus LL.

Methods: Forty-nine subjects, 24 male and 25 female, were prospectively enrolled. Patients with pre-existing spinopelvic pathology were excluded. Standing, relaxed-seated, and lateral decubitus lateral radiographs were obtained. Radiographic variables measured included LL and lordosis change at each lumbar level (e.g. L1-L2). The change in LL when going from a standing to a lateral decubitus position (ΔLL), the correlation between standing and sitting LL compared to lateral decubitus LL, and the correlation between ΔLL and standing pelvic incidence (PI), pelvic tilt (PT), PI-LL mismatch, pelvic femoral angle (PFA), and sacral slope (SS) were calculated.

Results: Subjects had an average age of 25.7 ± 2.3 years and body mass index of 24.1 ± 3.0 kg/m². On average, 11.9°±8.2° (range - 7° to 29°) of LL was lost when transitioning from a standing to the lateral decubitus position. Lateral decubitus LL had a higher correlation with standing LL (R = 0.725, p < 0.001) than with relaxed-seated LL (R = 0.434, p < 0.001). Standing PT and PI-LL mismatch had moderately negative correlations with ΔLL (R=-0.58 and R=-0.59, respectively, both p < 0.05). Standing PI and standing PFA had a low negative correlation with ΔLL (R=-0.31 and R=-0.44, respectively, both p < 0.05) Standing SS and LL had no correlation with ΔLL.

Conclusions: Standing LL was strongly correlated to lateral decubitus LL, although subjects lost an average of 11.9° from the standing to the lateral decubitus position. This has important implications for fusion in the lateral position.