The Effect of Kneeling During Spine Surgery on Leg Intramuscular Pressure

Abstract

The 90/90 kneeling position results in elevated intramuscular pressure in the anterior compartment of the leg. This elevated pressure correlates also with subject weight. The 90/90 kneeling position may predispose patients to the development of an acute compartment syndrome during prolonged spine surgery, with heavier patients being at increased risk. In certain instances, the surgeon may consider using the 45/45 suspended position to minimize this risk.

Arthroscopic Treatment of Osteochondral Lesions of the Talus in a Suspended Position With the Patient in a Prone Position

“…There are several reports of compartment syndrome developing in a normal leg after hemilithotomy position for urology or gynecology surgery, and even after orthopedic surgery. 17,28,30 In one study, placement of the uninjured leg in the leg holder in the hemilithotomy position increased the calf compartment pressure by more than 18 mmHg. 23 This immediate increase was suspected to be the result of direct mechanical compression from the leg holder.…”

“…Even when there is compression of the lower leg, it is widely accepted that prolonged time is the major factor associated with the development of acute compartment syndrome in the hemilithotomy position. 17,28,30 All patients who developed compartment syndrome on a normal leg stayed in the hemilithotomy position for more than 4 hours. The reason that acute compartment syndrome is extremely rare in ankle arthroscopy might be that most arthroscopic procedures rarely exceed 2 hours.…”