Study DesignProspective, randomised controlled, single centre study of 45 patients posted for two level lumbar fixation surgery in the prone position.PurposeTo compare intra-abdominal pressure (IAP), mean airway pressure mean airway pressure and blood loss during the spine surgery in prone position using three different positioning systems.Overview of LiteratureStudies have correlated IAP with the amount of perioperative bleeding. However, IAP and airway pressures while assessing the bleeding comparing two or more prone positioning systems are unclear.MethodsThis prospective study was conducted on a cohort of 45 patients scheduled for two-level lumbar fixation. Patients were randomly allocated to a spine table, Wilson's frame, and thermomodulated pads. Bladder pressure as an indicator of IAP, mean and peak airway pressures, and blood loss were monitored.ResultsIAP increased whenever patient position was changed to prone .The increase in pressure was more in the Wilson's frame group but was statistically significant only on prolonged positioning. Adopting the prone position always increased the mean airway pressure, but the increased was significant only in the Wilson's frame group. Mean airway pressure decreased in the spine table group and was statistically significant. The blood loss in the spine table group was significantly less as compared to the other groups.ConclusionsPositioning on a spine table results in less blood loss and low mean airway pressure. The Wilson's frame results in high IAP, increased mean airway pressure, and more blood loss. The thermomodulated frame increases mean airway pressure and produces a moderate increase in IAP and airway pressure.

A case of spontaneous subarachnoid pleural fistula following rupture of a thoracic meningocele into the pleural cavity is described in this article. The patient had symptoms of low-pressure headache and difficulty in breathing. The fistulous opening was closed near the foramina by rotating a vascularized muscle flap. After showing initial improvement the patient had a recurrence of symptoms after 6 weeks, with a small leak at the closure site. A lumbar thecoperitoneal shunt led to permanent cure. In this article we discuss the course of the disease, the symptoms, the diagnostic methods, and the various treatment modalities for subarachnoid pleural fistula.

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