Becker's Spine Review

14 Executive Briefing Sponsored by: S pine surgery is a daunting responsibility. With a patient's nervous system at risk in an operating room, it's essential to fill the operating room with superior equipment that complements the surgeon and patient. However, the equipment is not limited to forceps and scalpels or osteotomy techniques. Spine surgeons may also benefit from utilizing advanced operating tables like the ProAxis® Spinal Surgery Table. Mizuho OSI officially launched its ProAxis Spinal Surgery Table in July 2013. The table features software-controlled, hinge technology designed to support the biomechanical aspects of spinal and imaging procedures. With hinge technology, the ProAxis table supports instantaneous vertebral axis of rotation with coordinated patient translation. Surgeons can adjust the table to their desired degree of flexion and extension, providing direct visualization of intraoperative changes in vertebral alignment. Mizuho OSI developed the table to facilitate spinal canal decompressions and controlled closure for lumbar osteotomies as well as various minimally invasive surgeries. Before launching its most advanced surgical table, spine surgeons were accustomed to Mizuho OSI's Spinal Surgery Top and Radiolucent Imaging Top, which were part of the company's original Modular Table System (MTS). The table system was designed for anterior and posterior fusions, surgical correction procedures and decompressions, among other procedures. "The MTS became widely used in the 1990s and was very early on regarded as the standard for the operating room," said Brett Babat, MD, a spine surgeon with Nashville (Tenn.) Neurosurgery Associates. "The first generation of the active hinge tables was cumbersome and a little unpredictable, but as technology has evolved to the ProAxis Table, I see hinge tables in more facilities. Additionally, facilities have adopted more than one of these tables because it is becoming the new standard of care." Mizuho designed its ProAxis Table to provide an advanced positioning platform that supports a variety of procedures, including pedicle subtraction osteotomies, spinal fusions, and motion preservation surgery. Why patient positioning is important When performing lumbar spinal fusions, spine surgeons are focused on optimizing and maximizing safe neural decompression in positions with correct lordosis. With a traditional prone table, surgeons have a limited range within which to adjust the degree of lumbar lordosis. On other standard tables, surgeons are challenged with the force required to achieve lordosis. However, surgeons have a new option: tables that promote dynamic patient positioning. "One of the advantages of having active assistance from the table is I can start the patient in a less lordotic position, which makes the beginning of a decompression safer because there is more space for the neural elements," Dr. Babat said. "Then as the decompression progresses, I can increase the lordosis to where I want the patient to be, and the position the patient will most likely be in when he or she is upright. As we increase the lordosis, I can also track and see if there is stenosis occurring because of the repositioning." Patients in less lordotic positions show fewer impacted nerves; however, there are still areas where neurological nerves are present. Using tables that allow for active patient movement intraoperatively enable surgeons to identify nerves when a patient is in more lordotic positions. The ProAxis Table allows spine surgeons to remove bone, perform the decompression, place instrumentation and then use the table along with gravity to change the position of the patient's spine, requiring less force on the bone screw interface. "Having a table like the ProAxis allows surgeons to adjust lumbar lordosis intraoperatively based on what a surgeon sees," said Dr. Babat. "It also allows surgeons to maximize lumbar lordosis in fusion cases where it's even more important because surgeons are establishing a more permanent position in the lumbar spine. If surgeons don't get accurate lordosis, they are setting the patient up for long-term pain and multiple additional operations." How active hinge tables can lead to better spine surgery outcomes

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