Study Design. Cadaveric biomechanical study.
Objective. To quantify spinal motion created by transfer methods from supine to prone position in a cadaveric C1–C2 global instability model.
Summary of Background Data. Patients who have sustained a spinal cord injury remain at high risk for further secondary injury until their spine is adequately stabilized. To date, no study has evaluated the effect of patient transfer methods from supine to prone position in the operating room, on atlantoaxial cervical spine motion.
Methods. A global instability was surgically created at the C1–C2 level in 4 fresh cadavers. Two transfer protocols were tested on each cadaver. The log-roll technique entailed performing a standard 180° log-roll rotation of the supine patient from a stretcher to the prone position onto the operating room Jackson table (OSI, Union City, CA). The “Jackson technique” involved sliding the supine patient to the Jackson table, securing them to the table, and then rotating them into a prone position. An electromagnetic tracking device registered motion between the C1 and C2 vertebral segments. Three different head holding devices (Mayfield, Prone view, and blue foam pillow) were also compared for their ability to restrict C1–C2 motion. Six motion parameters were tracked. Repeated measures statistical analysis was performed to evaluate angular and translational motion.
Results. For 6 of 6 measures of angulation and translation, manual log-roll prone positioning generated significantly more C1–C2 motion than the Jackson table turning technique. Out of 6 motion parameters, 5 were statistically significant (P < 0.001–0.005). There was minimal difference in C1–C2 motion generated when comparing all 3 head holding devices.
Conclusion. The data demonstrate that manual log-roll technique generated significantly more C1–C2 motion compared to the Jackson table technique. Choice of headrest has a minimal effect on the amount of motion generated during patient transfer, except that the Mayfield device demonstrates a slight trend toward increased C1–C2 motion.
In the patient with atlantoaxial instability, positioning from supine to prone in the operating room may potentially cause neurologic deterioration. This cadaveric study demonstrates that the use of the Jackson table generates less C1–C2 motion than the log-roll for prone positioning.
From the *Department of Orthopaedics, University of Massachusetts Medical Center, Worcester, MA; †Department of Orthopaedic Research, University of Florida, Gainesville, FL; ‡Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, FL; §Department of Orthopaedics, Wright State University, Dayton, OH; ¶Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound, and Department of Rehabilition Medicine, University of Washington, Seattle, WA; and ∥Department of Orthopaedic Surgery, Spine Division, University of Rochester Medical Center, Rochester, NY.
Acknowledgment date: February 15, 2008. First revision date: June 19, 2008. Second revision date: May 9, 2009. Acceptance date: May 11, 2009.
The manuscript submitted does not contain information about medical device(s)/drug(s).
Foundation funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Address correspondence and reprint requests to Glenn Rechtine, MD, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14624; E-mail: email@example.com