15 Spine surgery
15.1 Cervical spine – 186
15.1.1 Supine position/CRP horseshoe-shaped headrest – 186 15.1.2 Supine position/skull clamp – 188
15.1.3 Supine position/spine holding unit MAQUET T554.0000 – 190 15.1.4 Prone position/CRP horseshoe-shaped headrest – 192 15.1.5 Prone position/spine holding unit / skull clamp – 194
15.2 Thoracic spine, lumbar spine – 196 15.2.1 Prone position – 196
15.2.2 Lateral position – 198
15.2.3 Supine position – 200
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15.1 Cervical spine
15.1.1 Supine position/ CRP horseshoe-shaped headrest
. Figs. 15.1, 15.2.
Indications
Ventral access to the upper and lower cervical vertebrae without the possibili- ty of intraoperative, external reposition measures for:
4 dens fractures, dens pseudarthrosis
4 posttraumatic lesions, misalignment and fractures in the upper and lower cervical vertebrae
4 tumours, spondylitis, spondylodiscitis
4 degenerative changes of the lower cervical vertebrae Preparations
4 Arm positioning devices 4 CRP horseshoe-shaped headrest
4 Shaving in the area of the incision and preoperative skin cleansing Positioning
4 Standard operating table position 1, position 2 or universal operating table
4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4 Fix and pre-position the CRP horseshoe-shaped headrest to the head part of the operating table
edge of the operating table, scapula still on the table
4 Position and fix the head on the CRP horseshoe-shaped headrest
4 Position both arms at the body with arm protection or secure the arms, possibly fixing with plasters
4 Apply the neutral electrode and connect to the HF surgery device
4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection
4 Position the operating lights 4 Patient warming system Risks
4 Normal positioning of the operating table in the theatre
4 M ove the patient towards the head end until the shoulders are at the upper
4 Iatrogenic injuries to the eyes and soft tissues (head fixing! )
. Fig. 15.1. Supine position on universal operating table with CRP back plate 1150.45 and CRP horseshoe-shaped headrest
. Fig. 15.2. Supine position on CRP operating table 1150.16 with CRP horseshoe-shaped headrest
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15.1.2 Supine position/skull clamp
. Figs. 15.3, 15.4.
Indications
Ventral access to the upper and lower cervical vertebrae with the possibility of intraoperative, external reposition measures for:
4 dens fractures, dens pseudarthrosis
4 posttraumatic lesions, misalignment and fractures in the upper and lower cervical vertebrae
4 tumours, spondylitis, spondylodiscitis Preparations
4 Arm positioning devices 4 Padded arm protection 4 Skull clamp
4 Shaving in the area of the incision and preoperative skin cleansing Positioning
4 Standard operating table position 1, position 2 or universal operating table
4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4 Fix and pre-position the skull clamp to the head part of the operating table
edge of the operating table, scapula still on the table 4 Position and fix the head in the skull clamp
4 Position both arms at the body with arm protection or secure the arms, possibly fixing with plasters
4 Apply the neutral electrode and connect to the HF surgery device
4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection
4 Position the operating lights 4 Patient warming system Risks
4 Iatrogenic injuries at the skull clamp
4 Normal positioning of the operating table in the theatre
4 M ove the patient towards the head end until the shoulders are at the upper
. Fig. 15.3. Supine position on universal operating table with CRP back plate 1150.45 and CRP skull clamp
. Fig. 15.4. Supine position on CRP operating table 1150.16 with CRP skull clamp
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15.1.3 Supine position/spine holding unit MAQUET T554.0000
. Figs. 15.5, 15.6.
Indications
Ventral access to the upper and lower cervical vertebrae with the possibility of intraoperative, external reposition measures for:
4 dens fractures, dens pseudarthrosis
4 posttraumatic lesions, misalignment and fractures in the upper and lower cervical vertebrae
4 tumours, spondylitis, spondylodiscitis Preparations
4 Arm positioning devices 4 Padded arm protection 4 4 Gel cushion
4 Shaving in the area of the incision and preoperative skin cleansing Positioning
4 Standard operating table position 1, position 2 or universal operating table
4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
4
4 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4 Fit part 1 (adapter) to the side rails of the head plate
4 Connect part 2 (telescopic bar) and part 3 (moving foot section) and fasten to part 1 (adapter)
4 4
edge of the operating table, scapula still on the table
4 4 Position both arms at the body with arm protection or secure the arms, possibly fixing with plasters
4
to part 2 (telescopic bar) for intraoperative reposition and positioning 4 Position the image converter
4 Apply the neutral electrode and connect to the HF surgery device
4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection
4 Position the operating lights 4 Patient warming system Risks
4 Injuries at the head and skull clamp from the halo ring Spine holding unit T544.0000
Fit part 5 (special adapter with 4 short bars in ball bearings) to the ready positioned halo ring
Normal positioning of the operating table in the theatre
Fasten part 4 (screw tension device) to part 2 (telescopic bar)
Move the patient towards the head end until the shoulders are at the upper Fasten part 5 (special adapter) to part 4 (screw tension device)
Possibly fit a radiolucent neck rest adjustable in height (hypomochlion, 6)
. Fig. 15.5. The head is fixed firmly in the
»Wilde« halo ring and fastened with an adap- ter to the spindle
. Fig. 15.6. The hypomochlion is positioned under the vertebra being operated to sup- port the cervical spine
5
4
6
1
2
3
5
4
2 6
1
15
15.1.4 Prone position/CRP horseshoe-shaped headrest
. Figs. 15.7, 15.8.
Indications
Rear access to the upper and lower cervical vertebrae without the possibility of intraoperative, external reposition measures for:
4 pseudarthrosis in the upper cervical vertebrae
4 posttraumatic lesions, fractures and misalignment at the occipitocervical junction and at the upper and lower cervical vertebrae
4 tumours Preparations
4 Arm positioning devices 4 Padded arm protection
4 Thorax, pelvic and wedge cushions, padded roll 4 Special bolster for prone position
4 CRP horseshoe-shaped headrest 4 Gel cushion
4 Shaving in the area of the incision and preoperative skin cleansing Positioning
4 Standard operating table position 1, position 2 or universal operating table
4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
4 Transfer to the prepared operating table in the induction room 4 Position both tables next to each other, with the prepared table lowered 4 Place the patient in the prone position on the padded cushion on the
prepared operating table and take him into the theatre
4 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4 Position the head on the special head positioning cushion
4 Position the axillae freely with the thorax bolsters and ensure that the pelvic bolster finishes with the anterior superior iliac crest
4 Position both arms on the arm positioning devices
4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange self-adhesive drapes for preoperative skin disinfection 4 Position the operating lights
4 Patient warming system Risks
4
Normal positioning of the operating table in the theatre
Iatrogenic injuries to the eyes and soft tissues (head fixing!)
. Fig. 15.7. Prone position on universal ope- rating table with CRP back plate 1150.45 and CRP horseshoe-shaped headrest
. Fig. 15.8. CRP horseshoe-shaped headrest with gel padding for very comfortable positioning
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15.1.5 Prone position/spine holding unit/skull clamp
. Figs. 15.9–15.12.
Indications
Rear access to the upper and lower cervical vertebrae with the possibility of intraoperative, external reposition measures for:
4 pseudarthrosis in the upper cervical vertebrae
4 posttraumatic lesions, fractures and misalignment at the occipitocervical junction and at the upper and lower cervical vertebrae
4 tumours Preparations
4 Arm positioning devices 4 Padded arm protection
4 Thorax, pelvic and wedge cushions, padded roll 4 Special bolster for prone position
4 Vertebral column holding unit/skull clamp 4 Gel cushion
4 Shaving in the area of the incision and preoperative skin cleansing Positioning
4 Standard operating table position 1, position 2 or universal operating table
4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
4 Transfer to the prepared operating table in the induction room 4 Position both tables next to each other, with the prepared table lowered 4 Place the patient in the prone position on the padded cushion on the
prepared operating table and take him into the theatre 4 4
4 4 4
4
4 Position both arms at the body with arm protection or secure the arms, possibly fixing with plasters
4 Position the axillae freely with the thorax bolsters and ensure that the pelvic bolster finishes with the anterior superior iliac crest
4 Position the image intensifier
4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights
4 Patient warming system Risks
4 Iatrogenic injuries at the skull clamp
4 Injuries to the head and at the skull clamp caused by the halo ring Normal positioning of the operating table in the theatre
When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
Fit part 5 (special adapter with 4 short bars in ball bearings) to the ready positioned halo ring
Fit part 1 (adapter) to the side rails of the head plate
Connect part 2 (telescopic bar) and part 3 (moving foot section) and fasten to part 1 (adapter)
Fasten part 4 (screw tension device) to part 2 (telescopic bar)
Fasten part 5 (special adapter) to part 4 (screw tension device)
4
. Fig. 15.9. The head is fixed firmly in the
»Wilde« halo ring and fastened with an adapter to the spindle
. Fig. 15.12. One image intensifier for each scanning level
. Fig. 15.11. Spine holding unit on Maquet 1120 with a Bekhterev patient in prone position
. Fig. 15.10. Stable fixing of the head with the halo ring 1
2
3 4 5
1
2 5
4
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15.2 Thoracic spine, lumbar spine
15.2.1 Prone position
. Figs. 15.13–15.17.
Indications
Rear access to the thoracic and lumbar spine and costotransversectomy for operating:
4 posttraumatic lesions, fractures and misalignment in the thoracic and lumbar spine
4 tumours, spondylitis, spondylodiscitis 4 scoliosis
4 spondylolisthesis Preparations
4 Arm positioning devices
4 Special head positioning cushion for prone position 4 Thorax, pelvic and wedge cushions, padded roll 4 Special bolster for prone position
4 Shaving in the area of the incision and preoperative skin cleansing
Positioning
4 Standard operating table position 1, position 2 or universal operating table
4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
4 Transfer to the prepared operating table in the induction room 4 Position both tables next to each other, with the prepared table lowered 4 Place the patient in the prone position on the padded cushion on the
prepared operating table and take him into the theatre
4 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4 Position the head on the special head positioning cushion
4 Position the axillae freely with the thorax bolsters and ensure that the pelvic bolster finishes with the anterior superior iliac crest
4 Position both arms on the arm positioning devices 4 Position the image intensifier
4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights
4 Patient warming system Risks
4 Iatrogenic injuries to the eyes and soft tissues of the head
Normal positioning of the operating table in the theatre
. Fig. 15.17. The image intensifier remains in swivelled adjustment during the operation
. Fig. 15.13. Prone position on universal operating table with CRP back plate 1150.45 and CRP head plate
. Fig. 15.14. By using the narrow CRP back plate 1150.45, the Iso-C3D can also be used in the prone position without any problems
. Fig. 15.15. Prone position on CRP operating table 1150.16 with CRP head plate for 360° use of image intensifier
. Fig. 15.16. Prone position on universal operating table 1150.30 with arm positioning in maximum 90° abduction
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15.2.2 Lateral position
. Figs. 15.18–15.22.
Indications
Thoracotomy, thoracolumbar access, lumbotomy for operating:
4 posttraumatic lesions, fractures and misalignment in the thoracic and lumbar spine
4 tumours, spondylitis, spondylodiscitis 4 scoliosis
4 spondylolisthesis Preparations
4 Arm positioning devices
4 Gel ring, gel cushion, Goepel leg holder, lateral supports, radial adjusting clamps, padded cushions (normal and flat) and wedge cushions or tunnel cushions, body belts
4 Shaving in the area of the incision and preoperative skin cleansing Positioning
4 Standard operating table position 1 or universal operating table
4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
4 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4 Fit the radial adjusting clamp to the side rail of the head plate, position the Goepel leg holder
4 Spread out the arm on the side not being operated 4 4
not lie directly on the shoulder
4 Fit the radial adjusting clamps to the side rails of the leg plates/head plate and position the body support on the level of the sacrum, symphysis and scapula, with the tip of the scapula positioned freely
4
1st possibility:position the legs with the padded cushions (normal and flat) and possibly wedge cushions
4 Fix the lower leg and positioning aids with the body belts 4
2nd possibility:position the legs with the tunnel cushion 4 Position the image intensifier
4 Apply the neutral electrode and connect to the HF surgery device
4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection
4 Position the operating lights
Normal positioning of the operating table in the theatre
Move the patient onto the healthy side
Move the lower arm forwards so that the weight of the upper body does
. Fig. 15.21. Back support at the scapula and sacrum . Fig. 15.20. Use of image intensifier from the side opposite the
surgeon
. Fig. 15.18. Lateral position on CRP operating table 1150.16 with 2 CRP accessory adapters
. Fig. 15.19. Lateral position on universal operating table with side positioning cushions for anatomic positioning of the lower arm
. Fig. 15.22. The image intensifier remains in swivelled adjustment during the operation
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15.2.3 Supine position
. Figs. 15.23–15.25.
Indications
Front access to the cervicothoracic junction and to the upper thoracic spine, thoracotomy, transperitoneal access, lumbotomy for operating:
4 posttraumatic lesions, fractures and misalignment in the thoracic and lumbar spine and in the lumbosacral junction
4 tumours, spondylitis, spondylodiscitis 4 scoliosis
4 spondylolisthesis Preparations
4 Arm positioning devices
4 Shaving in the area of the incision and preoperative skin cleansing Positioning
4 Standard operating table position 1, universal operating table
4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
4 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4 Position both arms in abduction position on the arm positioning devices 4 Apply the neutral electrode and connect to the HF surgery device
4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection
4 Position the operating lights 4 Patient warming system
Normal positioning of the operating table in the theatre
. Fig. 15.23. Supine position on CRP opera- ting table 1150.16 with arm positioning in maximum 90° abduction for operations to the lumbar spine
. Fig. 15.25. Arm protection from the elbow to the hand with arms positioned at the body . Fig. 15.24. Supine position on universal operating table with arms positioned at the body for operations to the thoracic spine
