Cervical Spine Positioning: A Comprehensive Guide

Cervical spine surgeries demand meticulous patient positioning to ensure both safety and optimal surgical outcomes. This article provides a detailed overview of the procedures, equipment, and considerations involved in cervical spine positioning, with a focus on the Allen Advance table equipped with the C-Flex attachment.

Patient Positioning for Cervical Spine Surgeries

Allen Advanced Table

For posterior cervical spine surgeries, the Allen Advance table with the C-Flex attachment offers three primary methods for positioning patients in the prone position:

• Logroll with Manual In-line Stabilization: This method involves securing the head using Mayfield pins before utilizing the Allen Advance table’s C-Flex head positioning system.

• "Sandwich and Flip" Technique: An alternative method for transitioning the patient to the prone position.

• Awake Prone Positioning: Reserved for specific cases requiring patient awareness during the positioning process.

In cases of cervical trauma or degenerative disease, patients are at increased risk of secondary neurological injury during transfer. To minimize this risk, a hard cervical collar is used to immobilize the neck during proning.

The C-Flex Head Positioning System

The C - Flex System

The C-Flex system is equipped with a quick-connector attachment for Mayfield tongs and bicycle handles that enable precise head and neck control. It supports intraoperative adjustments with an extensive range of motion, including:

• Height Adjustment: Up to 28 inches

• Lateral Adjustment: Up to 6 inches

• Extension: Up to 9 inches

  
  
  
  

These features allow surgeons to achieve and maintain optimal head and neck positioning throughout the procedure.

Application of Mayfield Pins

The Mayfield head holder utilizes three pins for secure head fixation. The pins are placed approximately 2.5–3.5 cm above the apex of the auricle. For adult patients, the torque screw is tightened until the single-pin marker indicates three lines, equivalent to 60 lbs (27 kg) of force.

Torque Setting

During the logroll technique, a minimum of four personnel is required to safely transition the patient from the supine to prone position. The surgeon maintains alignment of the head with the shoulders using the Mayfield holder, while the other team members assist in rolling the patient.

Adjusting Neck Positioning

The C-Flex system provides fine control over flexion and extension of the neck, facilitating precise adjustments during surgery. After robotic assistance is mounted, a full stretch of the patient’s arm ensures that all cervical trajectories remain accessible to the surgeon.

Final Positioning

Once the head and neck are securely positioned, the patient’s body is stabilized using appropriate padding:

• Under the chest and iliac crest: To reduce abdominal compression

• Arms: Positioned alongside the trunk and secured with tape

This final positioning ensures both patient comfort and surgical precision, while minimizing potential complications.