Special Technical ArticlesSkull Clamp Application: A Safe, Team-based Approach and Literature ReviewLand, Charles MD; Bowden, Blake MD; Callaway, Lamar MD; Henderson, Andrew MD; DeVine, John MDAuthor Information Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA The authors declare that they have nothing to disclose. For reprint requests, or additional information and guidance on the techniques described in the article, please contact Charles Land, MD, at [email protected] or by mail at Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, A1120 15th Street, BA 3300, Augusta, GA 30912. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques. Techniques in Orthopaedics: March 2021 - Volume 36 - Issue 1 - p 57-63 doi: 10.1097/BTO.0000000000000397 Buy Metrics Abstract Outcomes in posterior cervical spine surgery are highly dependent on proper operative head and neck positioning. As with any spinal procedure, posterior cervical surgery can be associated with significant morbidity; known complications directly related to positioning include postoperative vision loss, neurological injury, and poor surgical outcome. Unsurprisingly, a variety of techniques have been developed that aim to mitigate these complications while improving overall outcomes. The aim of this article is to present a standardized technique for application of the Mayfield skull clamp focusing on a team-based approach for patient positioning to minimize complications. The existing literature is also reviewed for complications associated with head positioning devices. Our method of clamp application and patient positioning minimizes complications (0.36% over a 14-y period), optimizes surgical exposure with anatomic position of the bony elements, and maximizes intraoperative spinal stability. This protocol is ideal for all the posterior cervical procedures. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.