Thoracic spine lumbar spine

15.2.1 Prone position

O 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 Normal positioning of the operating table in the theatre 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 4 Intraoperative loss of the achieved positioning (secondary dislocation)

D Fig. 15.17. The image intensifier remains in swivelled adjustment during the operation

O 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 Normal positioning of the operating table in the theatre 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 Move the patient onto the healthy side

4 Move the lower arm forwards so that the weight of the upper body does 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 4 Patient warming system

□ Fig. 15.22. The image intensifier remains in swivelled adjustment during the operation

O 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 Normal positioning of the operating table in the theatre 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

16.1 Pelvic girdle - 204

16.1.1 Supine position - 204

16.1.2 Lateral position - 206

16.1.3 Prone position - 208

16.2 Acetabulum - 210

16.2.1 Supine position - 210

16.2.2 Lateral position - 212

16.2.3 Prone position - 214

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