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Lumbotomy (L1-L4)

Preparation and positioning

Positioning for Lumbotomy (L1-L4)

Generally, the approach is done from the left side to avoid the liver and the vena cava. The patient is placed onto a radiolucent table and turned into the lateral decubitus position, left side up. 
 
The left arm is elevated and placed in a well-padded support and a cushion pad should be placed underneath the right axilla.

The knees should be slightly flexed. The knee and hip flexion allows relaxation of the psoas muscle.

Depending on surgeon preference, the table could have a tilting option. If selected, the tilting option should be located underneath the patient's thoracolumbar junction.

Pitfall
If the tilting option is used in the table, be careful to straighten the table prior to performing the instrumented fusion.