The majority of spine surgeries are done from the back of the spine. This necessitates that the patient is placed in a prone or facedown position. This is, of course, an unnatural position for a person to be placed. Therefore, it is extremely important for all sensitive areas of the body to be carefully assessed and padded prior to beginning the surgery. All of the extremities and its joints must be kept in neutral, natural positions.
Complications from positioning may include damage to blood vessels or nerves extending into the arms or legs, the surrounding skin, or injury to sensitive areas of the head and face. Such nerve or vessel damage could result in permanent numbness, weakness, pain, and inability to use the extremity. The surgical and anesthesia teams share the responsibility of assessing and positioning the patient onto the operating table.
The goal of safe prone positioning involves supporting the torso in areas where it can safely carry the weight of the body. To help with this, a specialized and well padded frame is used to support the body. This frame is called the Toronto Frame or the Jackson Table.
Areas to support include around the hips and pelvis to support the lower torso. The upper torso is supported along the chest and rib cage just below the armpit area. Care is taken to assure that the frame extending up into the armpit region does not cause blood vessel or nerve compression. In women, the breasts are positioned to minimize pressure as well. Despite this, short term breast soreness after surgery is common.
Head and face positioning and support are extremely important. For lengthy surgeries or for cervical surgeries, a head holding device called Gardner Wells tongs or Mayfield tongs may be used. These devices employ the use of small pins that are firmly affixed to the skull utilizing a clamp-like device. This provides good control of the head and prevents any areas of pressure. As imposing as this device sounds, please be aware that its usage is specifically to protect the face from unacceptable pressure and to control the head and neck. This device is put on after the patient is asleep and is removed prior to waking the patient. Small pinholes within the scalp hairline are the only evidence indicating the use of this device. The pinholes may be sore and irritated for several days after surgery.
The surgeons at CCSI may also use a specialized head support that gently cradles the face. The face is supported by the forehead and chin areas; both are less sensitive facial areas. The nose and the eyes are kept free of any pressure. For instance, pressure on the nose could cause skin damage. Pressure on the eyes could cause eye damage, visual loss, or even blindness.
Indeed, prone positioning is believed to place blood flow to the eyes at some risk, thus causing a small risk of visual loss or blindness. Unfortunately, this situation is poorly understood at this time. All of these complications are quite rare but are catastrophic in nature. At CCSI we take them very seriously and pay careful attention during all aspects of the positioning process.