title: The role and safety of the sitting position in instrumented cervical surgery.
abstract: Placing patients who are undergoing neurosurgical procedures to the cervical spine in the sitting position offers significant advantages. These must be counterbalanced against the risk of venous and paradoxical air embolism. This study addresses the role and safety of the sitting position for instrumented cervical surgery. Twenty-five consecutive patients who underwent instrumented cervical surgery in the sitting position were recruited via retrospective analysis. Complications arising from the surgical procedure - specifically venous air embolism - were recorded, as well as pre- and post-operative haemoglobin levels. The incidence of venous air embolism was 0% (97.5% one-sided confidence interval: 0-13.7%). However, five other complications occurred (incidence rate of 20% with a 95% confidence interval of 6.8-40.7%). With appropriate precautions, screening and specific indications, the sitting position can be safely used in more complex instrumented cervical surgery.
authors.affiliation: Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia. Electronic address: calvin.gan@mh.org.au.
authors.forename: Calvin
authors.initials: C
authors.lastname: Gan
authors.affiliation: Department of Neurosurgery, The Royal Melbourne Hospital, VIC, Australia.
authors.forename: James A
authors.initials: JA
authors.lastname: King
authors.affiliation: Department of Neurosurgery, The Alfred Hospital, VIC, Australia.
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Maartens
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery*; D004618:Embolism, Air / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D011187:Posture; D012189:Retrospective Studies; D055815:Young Adult
keywords: Air embolism; Cervical vertebrae; Instrumentation; Neurosurgery; Spine