Advertisement

Positioning for Anterior and Posterior Procedures

  • F. Cuzzocrea
  • M. Ghiara
Chapter

Abstract

Introduction: The positioning of the patient is the first step of a surgical procedure as the precision of the various elements of the surgery (reduction, fixation and decompression) depends on correct access to the spine, including intraoperative imaging.

For the cervical spine, the two principal types of positioning are supine and prone; lateral positioning is less frequent. Both interior and posterior access require the use of the following head positioners:
  • Mayfield (which immobilizes the spine and permits reduction in cases of fracture or deformity correction)

  • Three-point head positioner

  • Frontal or occipital horseshoe head pad

The achievement of a correct positioning, ensuring optimal access to surgical site in question, is confirmed by radiographic imaging.

Conclusion: Planning surgery and adhering to the plan real-time are the best forms of prevention of difficult surgery, mistakes and potential complications. In fact, the aim is to render the positioning procedure ‘safer’, prevent complications and help deal with them promptly should they arise, and improve the quality of surgery and ampliscopic imaging. The three key ingredients for success are knowledge, planning and teamwork.

References

  1. 1.
    Kamel I, Barnette R. Positioning patients for spine surgery: avoid uncommon position-related complications. World J Orthop. 2014;5(4):425–43.CrossRefGoogle Scholar
  2. 2.
    Sawier RJ, et al. Peripheral nerve injuries associated with anaesthesia. Anaesthesia. 2000;55:980–91.CrossRefGoogle Scholar
  3. 3.
    Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006;104:1319–28.Google Scholar
  4. 4.
    Baerts WD, de Lange JJ, Booij LH, et al. Complications of the Mayfield skull clamp. Anesthesiology. 1984;61:460–1.CrossRefGoogle Scholar
  5. 5.
    Denaro L, et al. Pitfalls in cervical spine surgery. Berlin: Springer; 2010.  https://doi.org/10.1007/978-3-540-85019-9_6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • F. Cuzzocrea
    • 1
  • M. Ghiara
    • 1
  1. 1.Clinica Ortopedica e TraumatologicaFondazione IRCCS Policlinico San MatteoPaviaItaly

Personalised recommendations