13.4. Patient positioning
@ProfFishchenkoWe position the patient prone without a Wilson frame, on a body positioner (Full-Body Prone Positioner). We place the head on a gel support (Gel Prone Head Pad). By adjusting the operating table, we achieve sufficient cervical flexion for access; we determine its degree individually, avoiding excessive flexion.
In my practice, we secure the head and trunk with packing tape to prevent slipping. We gently position the arms along the trunk and secure them in traction to reduce shoulder girdle overlap on lateral radiographs. We check that there is no excessive traction or compression.
We coordinate head and neck positioning with the anesthesiologist to preserve ventilation and venous outflow; we avoid pressure on the eyes. We place soft supports under the lower legs.
The anesthesiologist determines the target arterial pressure individually, maintaining adequate perfusion. In our practice, a systolic pressure of around 100 mmHg may be used under appropriate clinical conditions.
References
1. Kang MS, You KH, Han SY, Park SM, Choi JY, Park HJ. Percutaneous full-endoscopic versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical foraminal disc disease. Clin Orthop Surg. 2022;14(4):539–547. DOI: 10.4055/cios22050.
2. Heo DH. Biportal endoscopic posterior cervical foraminotomy with discectomy for unilateral radicular arm pain due to cervical herniated disc. Neurosurg Focus Video. 2024;10(2):V12. DOI: 10.3171/2024.1.FOCVID23225.
3. Saugel B, Fletcher N, Gan TJ, et al; POQI XI Workgroup. PeriOperative Quality Initiative (POQI) international consensus statement on perioperative arterial pressure management. Br J Anaesth. 2024;133(2):264–276. DOI: 10.1016/j.bja.2024.04.046.
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