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.

The Relevance of World Health Organization Surgical Safety Checklist to Spinal Surgery

“…A study by Kamel et al 75 identified significant changes in somatosensory evoked potential with the prone-superman comparted to the prone, arms tucked positions. Factors such as excessive elbow flexion (>90°), direct compression of the cubital tunnel, the arm migrating during surgery and obesity are known risk factors [76][77][78] . Traction neuropraxias and compression induced ischemic injuries of the brachial plexus occur due to mal-positioning in prone.…”

“…Traction neuropraxias and compression induced ischemic injuries of the brachial plexus occur due to mal-positioning in prone. Excessive arm abduction (>90) hypovolaemia, hypothermia, a history of alcohol dependency and diabetes mellitus are all risk factors 76 . Finally, LFCN injury has a reported incidence of 10%-24% during posterior spine surgery 79 , with compression at the anterior superior iliac spine the most prevalent cause, for example by supports or bolsters.…”

“…Finally, LFCN injury has a reported incidence of 10%-24% during posterior spine surgery 79 , with compression at the anterior superior iliac spine the most prevalent cause, for example by supports or bolsters. A lean build and prolonged surgeries are risk factors 76,79 .…”

Letter to the Editor: Patient Positioning in Spine Surgery: What Spine Surgeons Should Know?

“…We were intrigued by the article by Garg et al [ 1 ], which discussed position-related complications associated with the prone position. However, we still have some concerns about the article.…”

Response to Letter to the Editor: Patient Positioning in Spine Surgery: What Spine Surgeons Should Know?

“…We thank the authors for their interest in our article [ 1 ] and kind words of appreciation. The point wise reply for the concerns raised is as follows:…”