Positions in neurosurgery
Park bench position (Lateral oblique position)
Pepper et al. investigated the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures.
Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations - neutral (anterior mandible position), extended (tracheostomy position), and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer.
Results: In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4-C5, as well as at the cervicothoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6), and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1-2) joints.
Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid fracture type II and cervical spine fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as cervical vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of the safe management of patients with combined maxillofacial and cervical spine injury 1)