Considerations for the Positioning of the Surgeon for Anterior Cervical Surgical Approach

Abstract Aim: Outcome after anterior cervical spine procedure strongly depends on the mode of surgery used. Among other factors, the position of the surgeon is crucial for the achievement of an optimal result, as different pathologies require different approaches. We conducted the present study to demonstrate two different positions of the surgeon during the Anterior Cervical Discectomy and Fusion (ACDF) procedure and to compare the consecutive outcomes depending on the approach used. Methods: Data of patients undergoing ACDF procedure at the Department of Neurosurgery at Sana Hospital Duisburg, Germany, were retrospectively analyzed according to the position of the surgeon. Two different approaches were used: the surgeon was positioned either at the Top (T) or at the Shoulder (S) of the patient. Duration of surgical procedure, symptom relief and complication rates were compared between the two approaches using students t-test. Results: A total of 193 patients were identified for the present study; 120 received a (S) and 73 a (T) ACDF approach. The median number of accessed levels was 2, most patients complained from cervical radiculopathy (57.7%). Following surgery, symptoms improved in 33.1% of all patients (p<0.001). Complication rate was low, 14% of all patients required a second surgery. There was no difference in length of surgery, symptom relief or complication rates between the two surgical groups. Conclusion: Both approaches are equally safe and feasible. Outcome following ACDF procedure did not differ between the two methods applied. However, the approach differed depending on the underlying pathology and thus, the position of the surgeon should be taken into account and communicated to the surgical team including nurses and anesthetist prior to the surgical procedure.