Patient Positioning and Nerve Injury

Warner, Mark A.

doi:10.1016/s0889-8537(05)70290-x

Cited by 4 publications

(1 citation statement)

References 27 publications

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“…The use of shoulder braces and head-down position, arm malpositioning and prolonged neck extension were commonly identified mechanisms for brachial plexus injury [6] . The use of shoulder braces in Trendelenburg position may lead to compression of the brachial plexus between the clavicle and the first rib [8,63] . Brachial plexus injury is commonly due to overstretch of the brachial plexus [43] .…”

Section: Brachial Plexus Injurymentioning

confidence: 99%

Positioning patients for spine surgery: Avoiding uncommon position-related complications

Kamel

Barnette

2014

WJO

103

111

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Positioning patients for spine surgery is pivotal for optimal operating conditions and operative-site exposure. During spine surgery, patients are placed in positions that are not physiologic and may lead to complications. Perioperative peripheral nerve injury (PPNI) and postoperative visual loss (POVL) are rare complications related to patient positioning during spine surgery that result in significant patient disability and functional loss. PPNI is usually due to stretch or compression of the peripheral nerve. PPNI may present as a brachial plexus injury or as an isolated injury of single nerve, most commonly the ulnar nerve. Understanding the etiology, mechanism and pattern of injury with each type of nerve injury is important for the prevention of PPNI. Intraoperative neuromonitoring has been used to detect peripheral nerve conduction abnormalities indicating peripheral nerve stress under general anesthesia and to guide modification of the upper extremity position to prevent PPNI. POVL usually results in permanent visual loss. Most cases are associated with prolonged spine procedures in the prone position under general anesthesia. The most common causes of POVL after spine surgery are ischemic optic neuropathy and central retinal artery occlusion. Posterior ischemic optic neuropathy is the most common cause of POVL after spine surgery. It is important for spine surgeons to be aware of POVL and to participate in safe, collaborative perioperative care of spine patients. Proper education of perioperative staff, combined with clear communication and collaboration while positioning patients in the operating room is the best and safest approach. The prevention of uncommon complications of spine surgery depends primarily on identifying high-risk patients, proper positioning and optimal intraoperative management of physiological parameters. Modification of risk factors extrinsic to the patient may help reduce the incidence of PPNI and POVL. It is important for spine surgeons to be aware of PPNI and POVL to participate in safe, collaborative perioperative care of spine patients. Proper education of perioperative staff, combined with clear communication and collaboration while positioning patients in the operating room is the best and safest approach. The prevention of uncommon complications of spine surgery depends primarily on identifying high-risk patients, proper positioning and optimal intraoperative management of physiological parameters.Kamel I, Barnette R. Positioning patients for spine surgery: Avoiding uncommon position-related complications. World J Orthop

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Section: Brachial Plexus Injurymentioning

confidence: 99%