Prospective assessment of patient morbidity from prone sacral positioning
- 1 January 2012
- journal article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery: Spine
- Vol. 16 (1), 51-56
- https://doi.org/10.3171/2011.8.spine11560
Abstract
Sacrectomy positioning must balance surgical exposure, localization, associated operative procedures, and patient safety. Poor positioning may increase hemorrhage, risk of blindness, and skin breakdown. The authors prospectively identified positioning-related morbidity in 17 patients undergoing 19 prone sacral procedures from September 2008 to August 2009 following institution of a standardized positioning protocol. Key elements include skull traction/head suspension, an open radiolucent frame, and wide draping for associated closure and reconstructive procedures. Tumors included 5 chordomas, 4 high-grade sarcomas, 1 chondrosarcoma, 2 presacral extradural myxopapillary ependymomas, and 5 others. Mean patient age was 49.9 years (range 17-74 years); mean body mass index was 27.6 kg/m(2) (range 19.3-43.9 kg/m(2)). Mean preoperative Braden skin integrity score was 21.1 (range 17-23). Average operative time was 501 minutes (range 158-1136 minutes). Prone surgery was a part of staged anterior/posterior resections in 8 patients. Localization was conducted using fluoroscopy in 13 patients and intraoperative CT in 4 patients. All imaging studies were successful. One patient developed a transient ulnar nerve palsy attributed to positioning. Three patients (two of whom were morbidly obese) developed Stage I pressure injuries to the chest and another developed Stage II pressure injury following a 1136-minute procedure. Morbidity was only observed in patients with morbid obesity or with procedures lasting in excess of 10 hours. A positioning protocol using head suspension on an open radiolucent frame facilitates oncological sacral surgery with reasonable patient morbidity. Morbid obesity and procedure times in excess of 10 hours are risk factors for positioning-related complications. To the authors' knowledge, this is the first report of surgical positioning morbidity in this patient population.Keywords
This publication has 12 references indexed in Scilit:
- The American Society of Anesthesiologists Postoperative Visual Loss RegistryAnesthesiology, 2006
- Effect of Prone Positioning Systems on Hemodynamic and Cardiac Function During Lumbar Spine Surgery: An Echocardiographic StudySpine, 2006
- Prone Versus Knee-Chest Position for Microdiscectomy: A Prospective Randomized Study of Intra-abdominal Pressure and Intraoperative BleedingSpine, 2005
- The Incidence of Vision Loss due to Perioperative Ischemic Optic Neuropathy Associated With Spine SurgerySpine, 2005
- Unilateral Blindness after Prone Lumbar Spine SurgeryAnesthesiology, 2001
- Ophthalmic Complications After Spinal SurgerySpine, 1997
- Visual Loss as a Complication of Spine SurgerySpine, 1997
- Eye Injuries after Nonocular SurgeryAnesthesiology, 1996
- Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients.Stroke, 1983
- UNILATERAL BLINDNESS OCCURRING DURING ANESTHESIA FOR NEUROSURGICAL OPERATIONSAmerican Journal of Ophthalmology, 1954