Patient Positioning in Spine Surgery: What Spine Surgeons Should Know?

Abstract

Spine surgery has advanced tremendously over the last decade. The number of spine surgeries performed each year has also been increasing constantly. Unfortunately, the reporting of position-related complications in spine surgery has also been steadily increasing. These complications not only result in significant morbidity for the patient but also raises the risk of litigation for the surgical and anesthetic teams. Fortunately, most position-related complications are avoidable with basic positioning knowledge. Hence, it is critical to be cautious and take all necessary precautions to avoid position-related complications. We discuss the various position-related complications associated with the prone position, which is the most commonly used position in spine surgery, in this narrative review. We also discuss the various methods for avoiding complications. Furthermore, we briefly discuss less commonly used positions in spine surgery, like the lateral and sitting positions.

Keywords: Complications; Lateral position; Prone position; Safe spine surgery; Sitting position.

Fig. 1

The figure shows a patient positioned prone on a bolsters with arm on the top. The position is improper with respect to the position of the arms as hyper abduction and extension at the shoulders can be seen. It can also be noticed that the abdomen is not entirely free. Written informed consent for the publication of clinical images in the article was obtained from the patients.

Fig. 2

The use of Mayfield Clamp for positioning of head in spine surgery. Written informed consent for the publication of clinical images in the article was obtained from the patients.

Fig. 3

The figure shows a patient positioned prone on bolsters with use of Mayfield clamp for positioning of the head. The position of the arms with shoulder in flexion and no undue hyper abduction can be noticed. The abdomen hanging freely can also be seen. Written informed consent for the publication of clinical images in the article was obtained from the patients.

Fig. 4

Patient positioned in siting position. It can be noticed that the head has been flexed but hyper flexion has been avoided. The knees are also flexed to improve the venous return. Written informed consent for the publication of clinical images in the article was obtained from the patients.