Lumbar spine surgery positioning complications: a systematic review

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>There are a variety of surgical positions that provide optimal exposure of the dorsal lumbar spine. These include the prone, kneeling, knee-chest, knee-elbow, and lateral decubitus positions. All are positions that facilitate exposure of the spine. Each position, however, is associated with an array of unique complications that result from excessive pressure applied to the torso or extremities. The authors reviewed clinical studies reporting complications that arose from positioning of the patient during dorsal exposures of the lumbar spine.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>MEDLINE, Scopus, and Web of Science database searches were performed to find clinical studies reporting complications associated with positioning during lumbar spine surgery. For articles meeting inclusion criteria, the following information was obtained: publication year, study design, sample size, age, operative time, type of surgery, surgical position, frame or table type, complications associated with positioning, time to first observed complication, long-term outcomes, and evidence-based recommendations for complication avoidance.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Of 3898 articles retrieved from MEDLINE, Scopus, and Web of Science, 34 met inclusion criteria. Twenty-four studies reported complications associated with use of the prone position, and 7 studies investigated complications after knee-chest positioning. Complications associated with the knee-elbow, lateral decubitus, and supine positions were each reported by a single study. Vision loss was the most commonly reported complication for both prone and knee-chest positioning. Several other complications were reported, including conjunctival swelling, Ischemic orbital compartment syndrome, nerve palsies, thromboembolic complications, pressure sores, lower extremity compartment syndrome, and shoulder dislocation, highlighting the assortment of possible complications following different surgical positions. For prone-position studies, there was a relationship between increased operation time and position complications. Only 3 prone-position studies reported complications following procedures of less than 120 minutes, 7 studies reported complications following mean operative times of 121–240 minutes, and 9 additional studies reported complications following mean operative times greater than 240 minutes. This relationship was not observed for knee-chest and other surgical positions.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>This work presents a systematic review of positioning-related complications following prone, knee-chest, and other positions used for lumbar spine surgery. Numerous evidence-based recommendations for avoidance of these potentially severe complications associated with intraoperative positioning are discussed. This investigation may serve as a framework to educate the surgical team and decrease rates of intraoperative positioning complications.</jats:p></jats:sec>

Contemporaneous Evaluation of Intraoperative Ulnar and Median Nerve Somatosensory Evoked Potentials for Patient Positioning: A Review of Four Cases

“…The degradation in the median nerve SSEPs may also have been due to entrapment of the medial and/or lateral cords of the brachial plexus due to dislocation not affecting ulnar nerve contributions (De Latt et al 1994;Liveson 1984). Though shoulder dislocations are rare in surgery, the proximity of the median nerve in the axilla when they occur can cause a degradation to the median nerve SSEP intraoperatively (Shriver et al 2015). …”

Intraoperative angioedema induced by angiotensin II receptor blocker: a case report

“…Shriver et al [ 10 ] reviewed clinical studies reporting complications associated with positioning during lumbar spine surgery. The only reported upper airway complication was unusual intraoperative discovery of a bite injury, producing a cyanotic, edematous, protruding tongue.…”

Endoscopic Sciatic Nerve Decompression in the Prone Position—An Ischial-Based Approach

“…Complications from positioning in the prone position is a risk; however, this risk is small with operative times of less than 1 hour. 8 Exclusion of discogenic pain or radicular etiology is critical before performing a sciatic nerve decompression. 9 Nondiscogenic sciatic pain is a highly studied topic but remains controversial, and there is no gold standard for diagnosis.…”