Surgical Position for Lower Back Surgery: Prone (Jackknife) Position

The prone position (often called the jackknife or Keller position when the table is flexed) is standard for posterior lumbar spine surgery.

Setup

• Patient lies face-down on a specialized frame (Wilson, Andrews, or Jackson table).
• Head turned to side on padded horseshoe/face rest; neutral cervical alignment.
• Chest and pelvis supported to allow abdominal hanging—reduces venous pressure and epidural bleeding.
• Arms tucked or on armboards (<90° abduction).
• Knees slightly flexed, padded.

Advantages

• Direct posterior access to lumbar spine.
• Reduces vena cava compression → less intraoperative bleeding.
• Facilitates fluoroscopy.
• Lower risk of deep vein thrombosis vs. supine.

Considerations

Requires careful padding to prevent pressure injuries (face, chest, knees, genitalia). Hemodynamic changes on turning prone must be monitored. Not suitable for all patients (severe cardiopulmonary disease, unstable cervical spine).