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Archive December 2018 XIX, No. 12

Keys to Safe Spine Surgery Positioning

The keys to injury prevention - neutral positioning and proactive padding.

Jim Burger

Jim Burger, Senior Editor


LATERAL PASS A patient positioned laterally before spine surgery.

Sine surgery patients who aren’t properly positioned, padded or monitored are vulnerable to any number of complications, including pressure sores, nerve injuries and even vision loss. Overlook one detail and you may end up with devastating, potentially life-changing events.

The most common complication following lumbar spine surgery performed on patients in prone and knee-chest positions? Vision loss, researchers found ( It’s a potentially catastrophic turn of events for providers, too. A disc surgery patient who lost his vision after spending nearly 9 hours in the prone position and under general anesthesia won a $22 million malpractice suit ( How to prevent vision loss?

Use the reverse Trendelenburg to get the head above the level of the heart. “This will minimize edema,” says a New York CRNA. That’s in line with expert recommendations that you position patients, especially those considered high-risk, such that their heads are either at or above the height of their hearts.

Experts also suggest periodically checking head position both before and during surgery, as improper shifting can obstruct blood flow to the optic nerve. You should also keep a close eye on intraoperative eye swelling and pressure.

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