Posterior Approach to the Lower Lumbar Spine

Abstract

Bleeding from lumbar spinal surgery is best minimized by proper positioning of the patient to prevent abdominal pressure that increases spinal venous pressure. A variety of frames exist that allow proper positioning with the abdomen hanging free. Position the patient on a conventional operating table prone on the horseshoe-shaped Pheasant cushion with separate shoulder posts. Put the patient’s iliac crest line at the angle on the cushion and at the break in the table. Put the table in flexion and level the back by raising the head. Pad the knees with foam rubber and the shins and anterior borders of the feet with pillows. Flex the knees with the padded 60-degree wooden wedge. Always check the pulses and use TED stockings. Adequate decompression of the abdomen and free excursion of the chest is the objective. Use a frame that allows a free abdomen and good chest expansion while still allowing some flexion and extension of the table. The shoulder posts allow full chest expansion. Position the upper arms at no more than 90 degrees to the trunk and pad the ulnar notch to prevent ulnar neuropraxia.