Positioning for Spine Surgery

Proper positioning for spine surgery should allow access and ease of exposure, optimize operative ergonomics, facilitate manipulation of the spinal column, and simultaneously minimize the risk for complications detrimental to patient outcomes. Over the years, spine surgeons have utilized numerous techniques and devices (e.g., Mayfield clamp, Gardner-Wells tongs, ProneView protective helmet, and various surgical tables) to accomplish these goals. This chapter briefly reviews historical positioning equipment from the past century while discussing the central principles motivating these developments, namely, (1) reduction in abdominal compression to minimize vertebral venous engorgement and blood loss and (2) intraoperative manipulation of sagittal contour/alignment to facilitate either decompression or arthrodesis. We also provide detailed descriptions with accompanying video lectures outlining proper patient positioning for common spine operations using current tables/frames (i.e., Jackson table and Wilson frame). The positions most commonly used today for spine surgery include prone “superman” position, prone position with arms tucked, supine position with arms tucked or abducted, and lateral position. Each position has nuanced technical variations that can facilitate specific surgical approaches while limiting complication risks. We review some of these position-related complications, with focus on perioperative peripheral nerve injury and vision loss, and the potential strategies for their avoidance. Finally, special consideration is required when positioning patients with unstable spine injuries. New patient-transfer methods may reduce the risk for neurological injury from unstable segmental motion. Although current evidence is based on biomechanical cadaveric studies, the suggested tenet should likely be to minimize motion as much as possible.