Surgical Positioning

Abstract

Patient positioning is crucial for achieving optimal operating conditions and appropriate operative-site exposure. Correct surgical positioning is under the direct responsibility of the surgeon who is performing the procedure, as well as providing proper instructions to the entire operating room team in order to perform a safe procedure. During CVJ operations, patients are placed in non-physiological positions for hours, and this can lead to complications. Prone position is associated with risk of ophtalmic complications, peripheral nerves compressions, venous congestion and cervical cord compression.

Eye discharge can occur in the so-called Concorde position, which is the most used one. In this position, the patient is fixed with a three-pin head clamp (Mayfield) without any eye globe compression. The lateral position is rarely used since it is critical for the shoulder joint, while the park bench position is preferred to the lateral one as it keeps the shoulders free.

Almost every CVJ operation requires the surgeons to work around the vertebral artery and its venous plexus, and massive bleeding can result from this intervention. Blood loss is often related to venous congestion due to excessive flexion or rotation of the head.

Another element that should be held in consideration is the fluoroscopic visualization of the surgical field, especially when performig a fusion. During hardware insertion the surgeon should always be able to visualize both entry points and trajectories on the fluoroscopic screen. Shoulders position as well as three-pin head clamp position should be accurately checked prior to skin incision to allow clear intraoperative fluoroscopic view in lateral and anteroposterior projections. 

In this chapter the Authors discuss in details the anterior, lateral and posterior surgical positioning, taking into consideration the possible associated risks and how to avoid them.