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Archive October 2020 XXI, No. 10

Thinking of Buying... Spine Tables

Delicate procedures demand dynamic patient positioning options.

Sheeraz Qureshi

Sheeraz Qureshi, MD, MBA

BIO

BACKBONES OF SUCCESS
BACKBONES OF SUCCESS Radiolucent frames and interchangeable attachments enhance surgical access and intraoperative imaging.

The risks and dangers of complex spine procedures are significant, so surgeons must work with specially designed tables that give them the access, visibility, versatility, positioning and control they require to treat patients safely and effectively. If you're expanding your facility's spinal offerings or thinking about bringing new cases into your outpatient ORs, you'll need tables made specifically for this growing specialty.

  • Versatility is key. Most spine tables used today are based on the Jackson table design. The nice thing about the Jackson table is it can be used for every operation a spine surgeon performs. For spine procedures taking place in the outpatient setting, you want to invest in one table on which you can swap different attachments and accessories that are easy to store and don't take up a lot of space.
  • A solid base. Leading spine tables have radiolucent surfaces to accommodate intraoperative imaging and a base that doesn't need to be changed, regardless of the types of procedures surgeons perform. This certainty about the table's footprint is well-suited to space-conscious surgery centers, where the goal is to keep OR set-ups as uniform and cookie-cutter as possible.

Because the uniform bases of the spine table always remains a constant, no matter what top is being used, it provides predictability for both staff and administration. The table never becomes a limiting factor in terms of the surgeries you can perform, because you know exactly how much floor space the table will occupy. This uniformity also helps turnover times, because you never have to move different tables in and out of the same OR to accommodate various types of spine surgeries.

When tables have a uniform base, moving around the OR, maneuvering equipment around the table and storing equipment underneath the surface becomes much more familiar and easier, which is important in spine surgeries. For example, when we need to take an intraoperative X-ray, we can easily maneuver fluoroscopy equipment around the table because the space underneath and around the surface is generous.

  • Interchangeable tops. Spine tables come with different attachments that allow you to reconfigure the surface for various procedures and patient positions. We can extend the length of our Jackson table as needed, for example, although we've rarely had to make that adjustment. The tallest patient I've had on the table was six-foot-seven. He fit on the standard configuration, but we could have extended the length of the table four to five inches in each direction.
The ability to reconfigure the top of the table with minimum fuss is key.

The ability to reconfigure the top of the table with minimum fuss is key. I work with a flat top for cases such as anterior cervical or lumbar fusion procedures where the patient is lying flat on their back. If a patient is placed in the prone position, we'll often add a Wilson frame, which provides padding for the patient's face and chest, and naturally positions them in a neutral posture that enables me to access the posterior part of the spine. We also use a configuration I call "Jackson with four posts," which involves attaching posts that make contact only with the patient's thighs, pelvis and chest, leaving the abdomen entirely free. The positioning of the posts changes the curvature of the patient's spine, which can be helpful when we're trying to reconstruct its alignment. By simply changing the position of the posts, the task becomes a bit easier.

Spine tables are fairly mature pieces of equipment, but there's at least one area in which they can improve. I perform a lot of minimally invasive surgeries that involve the use of tubular retractors, the arms of which connect to the table to ensure the retractor stays exactly where I want it while it's inside the patient. But the area where the arm connects to my table is through a holder that wasn't meant for a Jackson table. We end up jury-rigging the set-up, but I'd like to see manufacturers expand my options for how to attach these arms to tables. OSM

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