Positioning Techniques in Surgical Applications - part 7 pot

15 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 Chapter 15 · Spine surgery186 15 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 Dislocation, reposition loss 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! ) 15 187 . 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 15.1 · Cervical spine Chapter 15 · Spine surgery188 15 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 Dislocation, reposition loss 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 15 189 . 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 15.1 · Cervical spine Chapter 15 · Spine surgery190 15 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 4 Dislocation, reposition loss 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) 15 191 . 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 15.1 · Cervical spine 5 4 6 1 2 3 5 4 2 6 1 Chapter 15 · Spine surgery192 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 4 Dislocation, reposition loss Normal positioning of the operating table in the theatre Iatrogenic injuries to the eyes and soft tissues (head fixing!) 15 193 . 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 15.1 · Cervical spine Chapter 15 · Spine surgery194 15 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 4 Dislocation, reposition loss 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 [...]... 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 Normal positioning of the operating table in the theatre 4 When positioning the patient, take appropriate... bleeding 4 placement of the pelvic cingulum Preparations 4 Arm positioning devices 4 Possibly table extension 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, possibly table extension 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Normal positioning. .. radial adjusting clamps, padded cushions (normal and flat) and wedge cushions, 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 Normal positioning of the operating table in the theatre... cushion, padded roll Possibly table extension 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... access, Smith-Peterson access, extended iliofemoral access, extended Pfannenstiel access, modified Stoppa access Preparations 4 Arm positioning devices 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... padded roll Special bolster for prone position Shaving in the area of the incision and preoperative skin cleansing Positioning 15 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... Thorax, pelvic and wedge cushion, padded roll 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... the area of the incision and preoperative skin cleansing Positioning 16 4 Standard operating table position 1, position 2 or universal operating table, possibly table extension 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Normal positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent... operating table 1150.30 with bolsters (MHH) and use of the image intensifier Fig 16.24 Prone position on universal operating table 1150.30 with maximum longitudinal displacement towards the head for optimum use of the image intensifier 16 17 17 Upper extremities 17. 1 Shoulder 17. 1.1 17. 1.2 17. 1.3 Supine position – 218 Beach-chair position – 220 Prone position – 222 17. 2 Upper arm – 224 17. 2.1 17. 2.2... 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 15 201 15.2 · Thoracic spine, lumbar spine Fig 15.23 Supine position on CRP operating table 1150.16 with arm positioning in maximum . 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. loss 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. 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,