Issue link: https://beckershealthcare.uberflip.com/i/1545216
10 EXECUTIVE BRIEFING 1 EXECUTIVE BRIEFING Significant innovations and advances in anterior cervical discectomy and fusion (ACDF) surgery include minimally invasive techniques, AI-assisted customization, robotic assistance and 3D-printed and custom implants. However, despite these advances, patient positioning during surgery is an important aspect of ACDFs that has been overlooked and has lacked innovation. Surgeons and surgical teams continue to position patients with exactly the same makeshift methods they did decades ago. With surgeons in the U.S. performing 132,000 ACDF surgeries each year, and with an increasing percentage of ACDFs and other spine surgeries being performed at ASCs as a lower- cost site of care, there is increased focus on improving the safety and efficiency of these procedures, which is shining a spotlight on patient positioning. Driven by BoneFoam's innovative Nextend System, clinical teams are transforming patient positioning for spine surgery, particularly ACDF procedures. Why patient positioning matters The ultimate goal of spine surgery is to have the patient up, mobile and without pain as quickly as possible. Unfortunately, when patients are not positioned in a standardized, consistent way, it can affect surgical outcomes. "Patient positioning is really important," said Choll Kim, MD, a minimally invasive spine surgeon at Excel Spine in San Diego. "And it starts with consistency." In particular, the new wave of navigation and robotics in spine surgery relies on the consistency of anatomical landmarks throughout the procedure, from the incision to the end of the case. "This has elevated the importance around patient positioning across spine surgery, including anterior cervical spine procedures," said Peter Cole, executive vice president of BoneFoam. "Even with a highly skilled surgical team and advanced navigation, variability in operative landmarks over the course of a procedure can introduce unnecessary complexity into the surgical environment. Consistency in patient positioning plays a foundational role in enabling procedural precision, visualization, and reproducibility." Some spine surgeries also take a long time. If a patient is not in a good position for the entirety of a long case, it can lead to injuries, especially to a patient's skin. Archaic patient positioning Despite the importance of patient positioning during spine surgeries, standardization is almost non-existent. "Patients are still positioned like we're in the Stone Ages," Dr. Kim observed. "Each of us positions patients the way we learned in our fellowship, utilizing rolled up towels, one-liter IV bags or pillowcases. There's a consistency problem in patient positioning, which hasn't changed in 25 years." These makeshift positioning methods are not consistent — especially for patients of different sizes and body types — and frequently make it necessary to adjust and manipulate a patient, which can add risk. Positioning patients in this antiquated way is not efficient, as surgeons and team members might spend 30-45 minutes prior to a procedure dealing with patient positioning, in an environment where operating room time is limited and often valued at $60 to $120 per minute. Also problematic is the frequent use of tape in the OR. A patient's shoulders may be taped to the base of the table and there is no readjustment of the tape over the course of the entire case. The patient is essentially locked in, meaning the surgeon doesn't have good visualization of C6 and C7 because the shoulders are in the way. The makeshift positioning methods and use of excessive tape can lead to a prolonged and challenging procedure. BoneFoam's Nextend Positioning System Building on its success in having developed widely adopted patient-positioning solutions for the ortho trauma space, BoneFoam developed the Nextend Positioning System for cervical surgeries in collaboration with leading spine surgeons. Nextend modernizes patient positioning for cervical surgeries by eliminating outdated positioning methods and complex tape configurations that have limited the ability to achieve proper visualization of the lower cervical spine and have increased the risk of injury. With Nextend patients are intubated directly on an ergonomic positioner, where cervical extension is easily adjusted through the unique head support that can be modified f or d ifferent p atient p rofiles. Dr . Kim no ted th is headrest has eliminated his need to use head traction. Rethinking the basics: A new standard for patient positioning in ACDF surgery