A surgical technique for tape-free lateral decubitus positioning in lateral lumbar interbody fusion using a novel mechanical patient positioner.

Reliable lateral decubitus positioning is critical for safe and effective lateral lumbar interbody fusion (LLIF); however, traditional patient stabilization with adhesive taping can be time-consuming, inconsistent, and associated with skin shear or breakdown, particularly in high body mass index (BMI) or elderly patients. In this technical report, we describe the use of a mechanical patient positioning system as a tape-free method of stabilization designed to provide counter-pressure at the iliac crest, thoracic cage, and/or greater trochanter while allowing for fine adjustments in alignment. The system is mounted directly to the operating table and uses adjustable support arms with anatomically contoured pads to improve control of pelvic tilt, trunk rotation, and coronal balance during positioning Conceptually, this approach enables controlled, reproducible support at fixed bony landmarks and may facilitate positioning optimization during fluoroscopic imaging. Compared with traditional taping techniques, this system is intended to reduce reliance on variable manually applied tension and instead provide adjustable mechanical support. Potential advantages include improved positioning consistency, decreased dependence on skin-based traction, and the ability to make intraoperative adjustments after draping. In addition, the technique may streamline operating room (OR) workflow by reducing repeated repositioning maneuvers and minimizing setup variability between surgical teams. The ability to fine-tune patient alignment after preparation may be particularly useful in multilevel LLIF procedures and in patients with increased soft-tissue mobility. This report aims to: (I) outline the rationale for mechanical positioning in LLIF; (II) describe the technical application of a table-mounted positioning system; and (III) discuss its potential advantages and limitations relative to conventional taping methods. No quantitative outcome data are presented, and further study is required to evaluate clinical impact.