scholarly journals Prone Positioning of Patients with Cervical Spine Pathology

2019 ◽  
Vol 07 (02) ◽  
pp. 070-076
Author(s):  
Sarah L. Boyle ◽  
Zoe Unger ◽  
Vinay Kulkarni ◽  
Eric M. Massicotte ◽  
Lashmi Venkatraghavan
Keyword(s):  
Cervical Spine ◽  
Prone Position ◽  
Spine Surgery ◽  
Good Alternative ◽  
Neurological Injury ◽  
Prone Positioning ◽  
Cervical Spine Surgery ◽  
Advantages And Disadvantages ◽  
Flexion Extension ◽  
Spine Pathology

AbstractPatients with cervical trauma or degenerative disease often require surgical decompression and stabilization in the prone position and are at the risk of secondary neurological injury during this transfer. This review aims to explore the current literature on different methods of positioning patients prone and to identify the safest technique to achieve prone positioning in patients with an unstable cervical spine undergoing posterior cervical spine surgery. We searched the Embase, Medline, and Medline-in Process databases for literature in English related to prone positioning patients with cervical spine pathology undergoing spine surgery. Seventy-three citations were identified as relevant and reviewed in detail with 20 articles being identified as answering the clinical questions posed. Our literature review identified three methods of prone positioning patients with cervical pathology: logroll with manual in-line stabilization (MILS), rotating the patient on a specialized spinal table using a “sandwich and flip” technique, and awake prone positioning. Each of these methods has its own advantages and disadvantages. When comparing the degree of neck movement between positioning techniques, “sandwich and flip” rotation was associated with over 50% reduction in both flexion–extension and axial–lateral rotation as compared to logroll with MILS. Awake self-positioning of a patient is another alternative that allows for rapid neurological assessment after repositioning. A “sandwich and flip” is the safest way to turn a patient with cervical pathology into a prone position for surgery. For cooperative patients, who are physically capable, awake self-positioning is a good alternative.

Advantages and Disadvantages of the Use of Various Types of Interbody Implants in Cervical Spine Surgery. Critical Review of the Literature

2020 ◽  
Vol 22 (4) ◽  
pp. 213-222
Author(s):  
Bartosz Godlewski( ◽  
Maciej Dominiak
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Structural Design ◽  
Titanium Implants ◽  
Implant Fixation ◽  
Disc Disease ◽  
Cervical Spine Surgery ◽  
3 Dimensional ◽  
Advantages And Disadvantages

Background. Most cervical spine procedures in patients with degenerative disc disease involve discectomy and remo­val of osteophytes in posterior vertebral body surfaces followed by interbody stabilisation with an interbody implant. Interbody implants are made of a variety of materials, differing in structural design, shape and surface topography. Considering that fusion between the implant and host bone is crucial for long-term positive outcomes, the choice of an appropriate implant is significantly important clinically and continues to be an important area of study. Material and methods. Relevant published studies indexed by Medline were identified via PubMed and reviewed. The findings were combined with the authors’ experiences. The database query was based on keywords related to implants in cervical spine surgery. This article presents the currently most popular types of implants by describing their properties and indicating their strengths and weaknesses as well as differences between different implant types. Results. Currently, the most popular interbody cages in cervical spine surgery are polyetheretherketone (PEEK) im­plants, titanium-coated PEEK implants and titanium implants. Besides the type of material used, the shape and surface structure of an implant appear to be of significant importance for a successful bony fusion. Conclusions. 1. 3D printing and the ability to produce 3-dimensional porous-surfaced implants opens up considerable pro­spects for this technique in the production of modern interbody implants. 2. Implants that facilitate the engagement (interlocking) of greater volumes of bone (e.g. porous implants) offer better implant fixation, with the type of material used being less important.

scholarly journals Unilateral visual loss due to central retinal artery occlusion with total ophthalmoplegia following cervical spine surgery in prone position

2016 ◽  
Vol 7 (2) ◽  
pp. 191-193 ◽  
Author(s):  
Amit Raj ◽  
Sudesh Kumar Arya ◽  
Sunandan Sood
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Prone Positioning ◽  
Cervical Spine Surgery ◽  
Loss Of Vision ◽  
Retinal Artery

Background: Blindness after spinal surgery is a rare complication, but it is serious, irreversible and incurable. Central retinal artery occlusion (CRAO) is rare after spinal surgery and ophthalmoplegia is even rarer. Case: A 52-year-old male patient complained of loss of vision in right eye immediately after cervical spine surgery. On examination, the patient’s visual acuity in right eye was absent perception of light. Right eye pupil was dialated and relative afferent pupillary defect (RAPD) was present. Extraocular movements were absent in all gazes in right eye. Intra-ocular pressure (IOP) was 26 mmHg in right eye and 16 mmHg in the left. Posterior segment examination revealed blurred disc margin with ischemic whitening of retina, thin and attenuated retinal arterioles and a central cherry red spot in right eye. Left eye was essentially normal. Observations: The causal factors of blindness in the patient were likely ischemia of the retina after venous congestion or temporary arterial occlusion resulting from changes in pressure to the tissues of the orbit. Factors including prolonged prone positioning with head end dependent position and possibility of orbital compression by the headrest could have contributed to impaired venous drainage, increase in IOP and reduction in perfusion pressure. Conclusion: Loss of vision post spinal surgery is a rarest of complication yet grave and irreversible. Because the problem involves mainly prone positioning of the patient, an appropriate position should be found so that facial and ocular compression can be avoided.

The Effect of Position on PaCO2 and PETCO2 in Patients Undergoing Cervical Spine Surgery in Supine and Prone Position

2017 ◽  
Vol 29 (3) ◽  
pp. 298-303 ◽  
Author(s):  
Monu Yadav ◽  
Elmati Praveen Reddy ◽  
Ashima Sharma ◽  
Dilip Kumar Kulkarni ◽  
Ramachandran Gopinath
Keyword(s):  
Cervical Spine ◽  
Prone Position ◽  
Spine Surgery ◽  
Cervical Spine Surgery

scholarly journals Cervical spine surgery in professional athletes: a systematic review

2016 ◽  
Vol 40 (4) ◽  
pp. E10 ◽  
Author(s):  
Andrei F. Joaquim ◽  
Wellington K. Hsu ◽  
Alpesh A. Patel
Keyword(s):  
Systematic Review ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Disc Herniation ◽  
Cervical Disc Herniation ◽  
Return To Play ◽  
Cervical Disc ◽  
Cervical Spine Surgery ◽  
Spine Pathology ◽  
High Level

Cervical surgery is one of the most common surgical spinal procedures performed around the world. The authors performed a systematic review of the literature reporting the outcomes of cervical spine surgery in high-level athletes in order to better understand the nuances of cervical spine pathology in this population. A search of the MEDLINE database using the search terms “cervical spine” AND “surgery” AND “athletes” yielded 54 abstracts. After exclusion of publications that did not meet the criteria for inclusion, a total of 8 papers reporting the outcome of cervical spine surgery in professional or elite athletes treated for symptoms secondary to cervical spine pathology (focusing in degenerative conditions) remained for analysis. Five of these involved the management of cervical disc herniation, 3 were specifically about traumatic neurapraxia. The majority of the patients included in this review were American football players. Anterior cervical discectomy and fusion (ACDF) was commonly performed in high-level athletes for the treatment of cervical disc herniation. Most of the studies suggested that return to play is safe for athletes who are asymptomatic after ACDF for cervical radiculopathy due to disc herniation. Surgical treatment may provide a higher rate of return to play for these athletes than nonsurgical treatment. Return to play after cervical spinal cord contusion may be possible in asymptomatic patients. Cervical cord signal changes on MRI may not be an absolute contraindication for return to play in neurologically intact patients, according to some authors. Cervical contusions secondary to cervical stenosis may be associated with a worse outcome and a higher recurrence rate than those those secondary to disc herniation. The evidence is low (Level IV) and individualized treatment must be recommended.

scholarly journals Posterior Ischemic Optic Neuropathy after Cervical Spine Surgery

2021 ◽  
Vol 62 (10) ◽  
pp. 1449-1454
Author(s):  
Sung Do Cho ◽  
Dong Hyun Kim ◽  
Hee Kyung Yang ◽  
Jeong Min Hwang
Keyword(s):  
Visual Acuity ◽  
Cervical Spine ◽  
Prone Position ◽  
Spine Surgery ◽  
Steroid Therapy ◽  
Ischemic Optic Neuropathy ◽  
Epoetin Alfa ◽  
Cervical Spine Surgery ◽  
Posterior Ischemic Optic Neuropathy ◽  
Rbc Transfusion

Purpose: To describe a patient with posterior ischemic optic neuropathy (PION) after cervical spine surgery who recovered after treatment.Case summary: A 51-year-old woman presented with eye pain and decreased visual acuity in the left eye, which had begun 8 hours after cervical spine surgery in the prone position. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand motion in the left eye; a relative afferent pupillary defect was present in the left eye. Ductions and versions were normal with pain in the left eye. The results of slit lamp examination, fundoscopic examination, fluorescein angiography, and optical coherence tomography were unremarkable in both eyes. Brain and orbital magnetic resonance imaging showed no abnormal findings in the visual pathway, such as brain infarction or intracranial artery stenosis. The patient was diagnosed with PION in the left eye. Because postoperative anemia had developed with a rapid decrease in hemoglobin from 14.7 g/dL to 9.9 g/dL, red blood cell (RBC) transfusion was performed together with intravenous high-dose steroid therapy and subcutaneous epoetin alfa injection. After 3 weeks, the patient’s BCVA improved to 20/22 in the left eye.Conclusions: Unilateral PION developed after cervical spine surgery in the prone position. Visual improvement was observed after RBC transfusion, intravenous high-steroid therapy, and subcutaneous epoetin alfa injection.

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