Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Apr 18;6(3):351-9.
doi: 10.5312/wjo.v6.i3.351.

Complications associated with prone positioning in elective spinal surgery

J Mason DePasse  1 , Mark A Palumbo  1 , Maahir Haque  1 , Craig P Eberson  1 , Alan H Daniels  1
Affiliations
Review

Complications associated with prone positioning in elective spinal surgery

J Mason DePasse et al. World J Orthop. .

Abstract

Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient morbidity. Although many of these complications remain uncommon, the range of possible morbidities is wide and includes multiple organ systems. Perioperative visual loss (POVL) is a well described, but uncommon complication that may occur due to ischemia to the optic nerve, retina, or cerebral cortex. Closed-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal surgery. Peripheral nerve injuries, such as those caused by prolonged traction to the brachial plexus, are more commonly encountered postoperative events. Myocutaneous complications including pressure ulcers and compartment syndrome may also occur after prone positioning, albeit rarely. Other uncommon positioning complications such as tongue swelling resulting in airway compromise, femoral artery ischemia, and avascular necrosis of the femoral head have also been reported. Many of these are well-understood and largely avoidable through thoughtful attention to detail. Other complications, such as POVL, remain incompletely understood and thus more difficult to predict or prevent. Here, the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity.

Keywords: Complications; Patient positioning; Prevention and control; Prone position; Spine.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Patient positioning on an Andrews frame (A) and Wilson frame (B). Prone-Andrews frame. Digital image. www.pitt.edu; Wilson frame. Digital Image. Mizuho OSI. www.mizuhosi.com. Accessed Jan 22 2015.
Figure 2
Figure 2
Facial pressure ulcer from use of the Andrews frame. From Goodwin et al[38].
Figure 3
Figure 3
Gardner-Wells Tongs utilized to free the face during prone spine surgery.
See this image and copyright information in PMC

References

    1. Tabara Y, Tachibana-Iimori R, Yamamoto M, Abe M, Kondo I, Miki T, Kohara K. Hypotension associated with prone body position: a possible overlooked postural hypotension. Hypertens Res. 2005;28:741–746. - PubMed
    1. Dharmavaram S, Jellish WS, Nockels RP, Shea J, Mehmood R, Ghanayem A, Kleinman B, Jacobs W. Effect of prone positioning systems on hemodynamic and cardiac function during lumbar spine surgery: an echocardiographic study. Spine (Phila Pa 1976) 2006;31:1388–1393; discussion 1394. - PubMed
    1. Schonauer C, Bocchetti A, Barbagallo G, Albanese V, Moraci A. Positioning on surgical table. Eur Spine J. 2004;13 Suppl 1:S50–S55. - PMC - PubMed
    1. Slocum HC, O’neal KC, Allen CR. Neurovascular complications from malposition on the operating table. Surg Gynecol Obstet. 1948;86:729–734. - PubMed
    1. Nickels TJ, Manlapaz MR, Farag E. Perioperative visual loss after spine surgery. World J Orthop. 2014;5:100–106. - PMC - PubMed