The role and safety of the sitting position in instrumented cervical surgery

• The sitting position in instrumented cervical surgery offers significant advantages.
• However benefits must be balanced against the risk of venous air embolism.
• We report 0% incidence of venous air embolism.
• With appropriate precautions, the sitting position can be safely used.

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.