Prospective assessment of patient morbidity from prone sacral positioning

Clinical article

Courtney E. Sherman, Peter S. Rose, Lori L. Pierce, Michael J Yaszemski, Franklin H. Sim

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Object. Sacrectomy positioning must balance surgical exposure, localization, associated operative procedures, and patient safety. Poor positioning may increase hemorrhage, risk of blindness, and skin breakdown. Methods. The authors prospectively identified positioning-related morbidity in 17 patients undergoing 19 prone sacral procedures from September 2008 to August 2009 following institution of a standardized positioning protocol. Key elements include skull traction/head suspension, an open radiolucent frame, and wide draping for associated closure and reconstructive procedures. Results. Tumors included 5 chordomas, 4 high-grade sarcomas, 1 chondrosarcoma, 2 presacral extradural myxopapillary ependymomas, and 5 others. Mean patient age was 49.9 years (range 17-74 years); mean body mass index was 27.6 kg/m 2 (range 19.3-43.9 kg/m 2). Mean preoperative Braden skin integrity score was 21.1 (range 17-23). Average operative time was 501 minutes (range 158-1136 minutes). Prone surgery was a part of staged anterior/ posterior resections in 8 patients. Localization was conducted using fluoroscopy in 13 patients and intraoperative CT in 4 patients. All imaging studies were successful. One patient developed a transient ulnar nerve palsy attributed to positioning. Three patients (two of whom were morbidly obese) developed Stage I pressure injuries to the chest and another developed Stage II pressure injury following a 1136-minute procedure. Morbidity was only observed in patients with morbid obesity or with procedures lasting in excess of 10 hours. Conclusions. A positioning protocol using head suspension on an open radiolucent frame facilitates oncological sacral surgery with reasonable patient morbidity. Morbid obesity and procedure times in excess of 10 hours are risk factors for positioning-related complications. To the authors' knowledge, this is the first report of surgical positioning morbidity in this patient population.

Original languageEnglish (US)
Pages (from-to)51-56
Number of pages6
JournalJournal of Neurosurgery: Spine
Volume16
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Morbidity
Morbid Obesity
Suspensions
Head
Ulnar Neuropathies
Chordoma
Pressure
Ependymoma
Thoracic Injuries
Skin
Chondrosarcoma
Fluoroscopy
Operative Surgical Procedures
Traction
Blindness
Patient Safety
Operative Time
Skull
Sarcoma
Body Mass Index

Keywords

  • Morbidity
  • Prone positioning
  • Sacrectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Prospective assessment of patient morbidity from prone sacral positioning : Clinical article. / Sherman, Courtney E.; Rose, Peter S.; Pierce, Lori L.; Yaszemski, Michael J; Sim, Franklin H.

In: Journal of Neurosurgery: Spine, Vol. 16, No. 1, 01.2012, p. 51-56.

Research output: Contribution to journalArticle

Sherman, Courtney E. ; Rose, Peter S. ; Pierce, Lori L. ; Yaszemski, Michael J ; Sim, Franklin H. / Prospective assessment of patient morbidity from prone sacral positioning : Clinical article. In: Journal of Neurosurgery: Spine. 2012 ; Vol. 16, No. 1. pp. 51-56.
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abstract = "Object. Sacrectomy positioning must balance surgical exposure, localization, associated operative procedures, and patient safety. Poor positioning may increase hemorrhage, risk of blindness, and skin breakdown. Methods. The authors prospectively identified positioning-related morbidity in 17 patients undergoing 19 prone sacral procedures from September 2008 to August 2009 following institution of a standardized positioning protocol. Key elements include skull traction/head suspension, an open radiolucent frame, and wide draping for associated closure and reconstructive procedures. Results. Tumors included 5 chordomas, 4 high-grade sarcomas, 1 chondrosarcoma, 2 presacral extradural myxopapillary ependymomas, and 5 others. Mean patient age was 49.9 years (range 17-74 years); mean body mass index was 27.6 kg/m 2 (range 19.3-43.9 kg/m 2). Mean preoperative Braden skin integrity score was 21.1 (range 17-23). Average operative time was 501 minutes (range 158-1136 minutes). Prone surgery was a part of staged anterior/ posterior resections in 8 patients. Localization was conducted using fluoroscopy in 13 patients and intraoperative CT in 4 patients. All imaging studies were successful. One patient developed a transient ulnar nerve palsy attributed to positioning. Three patients (two of whom were morbidly obese) developed Stage I pressure injuries to the chest and another developed Stage II pressure injury following a 1136-minute procedure. Morbidity was only observed in patients with morbid obesity or with procedures lasting in excess of 10 hours. Conclusions. A positioning protocol using head suspension on an open radiolucent frame facilitates oncological sacral surgery with reasonable patient morbidity. Morbid obesity and procedure times in excess of 10 hours are risk factors for positioning-related complications. To the authors' knowledge, this is the first report of surgical positioning morbidity in this patient population.",
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