14.4. Patient positioning

We position the patient prone on a Full-Body Prone Positioner, without a Wilson frame. We place the head on a Gel Prone Head Pad. By adjusting the operating table, we achieve sufficient cervical flexion for access; we determine the degree of flexion individually.

In our practice, we secure the head and trunk with packing tape to prevent slipping. We position the arms along the body and secure them with tape in traction. This facilitates lateral fluoroscopic imaging by reducing shoulder girdle overlap over the lower cervical segments. We check secure fixation and the absence of excessive pressure on soft tissues.

We align the head with the axis of the neck, avoiding excessive flexion and impaired blood flow. The anesthesiologist determines the target arterial pressure individually while ensuring adequate perfusion. In our practice, when clinically acceptable, we aim for a systolic pressure of around 100 mmHg. We place soft cushions under the lower legs.

References

1. Kang MS, et al. Percutaneous full-endoscopic versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical foraminal disc disease. Clinics in Orthopedic Surgery. 2022;14(4):539–547.

2. Kim JY, et al. Comparative analysis of 3 types of minimally invasive posterior cervical foraminotomy for foraminal stenosis, uniportal-, biportal endoscopy, and microsurgery: radiologic and midterm clinical outcomes. Neurospine. 2022;19(1):212–223.

3. Saugel B, Fletcher N, Gan TJ, et al. PeriOperative Quality Initiative (POQI) international consensus statement on perioperative arterial pressure management. British Journal of Anaesthesia. 2024;133(2):264–276.

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