The ideal patient positioning in spine surgery: a preventive strategy

Paulo Diogo Cunha, Tiago P Barbosa, Guilherme Correia, Rafaela Silva, Nuno Cruz Oliveira, Pedro Varanda, Bruno Direito-Santos, Paulo Diogo Cunha, Tiago P Barbosa, Guilherme Correia, Rafaela Silva, Nuno Cruz Oliveira, Pedro Varanda, Bruno Direito-Santos

Abstract

Patient positioning on the surgical table is a critical step in every spine surgery. The most common surgical positions in spine surgery are supine, prone and lateral decubitus. There are countless lesions that can occur during spine surgery due to patient mispositioning. Ulnar nerve and brachial plexus injuries are the most common nerve lesions seen in malpositioned patients. Devastating complications due to increased intraocular pressure or excessive abdominal pressure can also occur in prone decubitus and are real concerns that the surgical team must be aware of. All members of the surgical team (including surgeons, anesthesiologists and nurses) should know how to correctly position the patient, identify possible positioning errors and know how to avoid them in order to prevent postoperative morbidity. This work pretends to do a review of the most common positions during spine surgery, alert to errors that can happen during the procedure and how to avoid them.

Keywords: compressive neuropathies; patient positioning; perioperative visual loss; spine surgery.

Figures

Figure 1
Figure 1
Neck position for anterior approach of the cervical spine.
Figure 2
Figure 2
Supine position for anterior approach of the cervical spine.
Figure 3
Figure 3
Leg position in supine decubitus.
Figure 4
Figure 4
Supine position in lumbar spine surgery.
Figure 5
Figure 5
Da Vinci position for anterior approach to lumbar spine.
Figure 6
Figure 6
Concorde position for posterior approach to cervical spine.
Figure 7
Figure 7
Prone position for posterior approach to lumbar spine.
Figure 8
Figure 8
Leg and foot position in ventral decubitus.
Figure 9
Figure 9
Prone position on Wilson frame.
Figure 10
Figure 10
Lateral decubitus for lateral approach to lumbar spine.

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