Title : Prone positioning using longitudinal bolsters alone in paediatric spinal deformity surgery with pectus carinatum: A case series and literature review
Abstract:
Aim: To describe our experience and technique when positioning patients with PC for the purpose of spinal surgery. Longitudinal bolsters were used for positioning rather then chest pads.
Methods: Two paediatric patients with kyphoscoliosis and PC were selected as they required posterior spinal surgery in the prone position. An Allen table was used to position the patient. Rather than using the conventional chest pad, longitudinal bolsters were used to reduce high pressure areas. Intra-operative haemodynamic parameters, ventilatory mechanics, and positioning-related complications were reviewed. A focussed literature review prioritising studies from the last twenty years was performed.
Results: Procedures were completed without perioperative or positioning-related complications. No comparative or prospective studies evaluating bolsters-only prone positioning in patients with PC and scoliosis were identified. The contemporary evidence comprises isolated case report in pectus excavatum with scoliosis, where repositioning onto longitudinal bolsters alleviated suspected thoracic-or-cardiac compression.
Conclusion: Evidence guiding prone positioning in patients with combined PC and kyphoscoliosis is limited. Within the limitations of this series, it proposes that longitudinal bolsters alone may be a safe and effective method for positioning patients prone for the purpose of posterior spinal surgery. Further studies are required to define optimal positioning in this high-risk group.
Keywords: Prone positioning; spinal deformity; chest wall deformity; pectus carinatum; paediatric spine surgery.
