Cervical spine

15.1.1 Supine position/ CRP horseshoe-shaped headrest

O Figs. 15.1, 15.2. Indications

Ventral access to the upper and lower cervical vertebrae without 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 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

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 Fix and pre-position the CRP horseshoe-shaped headrest to the head part of the operating table 4 Move the patient towards the head end until the shoulders are at the upper 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 Iatrogenic injuries to the eyes and soft tissues (head fixing!) 4 Dislocation, reposition loss

Arm Supine Position
D Fig. 15.1. Supine position on universal operating table with CRP back plate 1150.45 and CRP horseshoe-shaped headrest

D Fig. 15.2. Supine position on CRP operating table 1150.16 with CRP horseshoe-shaped headrest

15.1.2 Supine position/skull clamp

O 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

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 Fix and pre-position the skull clamp to the head part of the operating table

4 Move the patient towards the head end until the shoulders are at the upper 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

□ Fig. 15.4. Supine position on CRP operating table 1150.16 with CRP skull clamp i\

Padded Prone Position Image Surgery

15.1.3 Supine position/spine holding unit MAQUET T554.0000

O 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 Spine holding unit T544.0000 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 Fit part 5 (special adapter with 4 short bars in ball bearings) to the ready positioned halo ring 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 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 Fasten part 4 (screw tension device) to part 2 (telescopic bar) 4 Move the patient towards the head end until the shoulders are at the upper edge of the operating table, scapula still on the table 4 Fasten part 5 (special adapter) to part 4 (screw tension device) 4 Position both arms at the body with arm protection or secure the arms, possibly fixing with plasters 4 Possibly fit a radiolucent neck rest adjustable in height (hypomochlion, 6)

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

D Fig. 15.5. The head is fixed firmly in the »Wilde« halo ring and fastened with an adapter to the spindle

15.1.4 Prone position/CRP horseshoe-shaped headrest

O 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 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 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 Iatrogenic injuries to the eyes and soft tissues (head fixing!) 4 Dislocation, reposition loss

Plate Carrier For Prone Position

D Fig. 15.7. Prone position on universal operating table with CRP back plate 1150.45 and CRP horseshoe-shaped headrest

D Fig. 15.8. CRP horseshoe-shaped headrest with gel padding for very comfortable positioning

15.1.5 Prone position/spine holding unit/skull clamp

O 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 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 part 5 (special adapter with 4 short bars in ball bearings) to the ready positioned halo ring 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 Fasten part 4 (screw tension device) to part 2 (telescopic bar) 4 Fasten part 5 (special adapter) to part 4 (screw tension device) 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

Maquet Skull Clamp

D Fig. 15.9. The head is fixed firmly in the »Wilde« halo ring and fastened with an adapter to the spindle

Halo Vertebra

D Fig. 15.11. Spine holding unit on Maquet 1120 with a Bekhterev patient in prone position

D Fig. 15.12. One image intensifier for each scanning level

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