The patient is positioned on a Wilson frame on a radiolucent table.

The head is placed in a padded face mask to avoid pressure on the eyes and have the endotracheal tube free with the neck in a neutral position.
The abdomen should hang free to avoid high intraabdominal pressure and subsequent venous pressure causing excessive bleeding of the spine.
The arms/shoulders should rest comfortably in a 90° position of the shoulder and elbow. Ensure the wrists and elbows are adequately padded to prevent a peripheral neuropathy.
Adequate padding must be provided to elbows and knees to avoid pressure sores.
A small bump or blanket roll should be placed under the legs to flex the knees slightly.

Positioning should attempt to maintain/increase lumbar kyphosis, which opens up the interlaminar and foraminal spaces.

Pearl

When performing fusion surgery, the frame's kyphosis must be removed in order to achieve a lumbar lordosis before adding the rods. If this is not done, then post-surgical flatback may occur.

It must be possible to obtain radiographic images in both AP and lateral planes at all times.

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