How the University of Minnesota uses a hinged spine surgery table to improve surgical outcomes: 4 quotes from 4 spine surgeons

Eric Oliver -  

A motorized hinge table can improve a spine surgeon's workflow during transforaminal lumbar interbody fusion and Pedicle Subtraction Osteotomy procedures. In addition to opening the intervertebral space for easier access, the table can also assist surgeons with lordosis correction. 

Exploring how a motorized hinge table improved spine surgery outcomes was the subject of a recent webinar, hosted by Becker's Spine Review and sponsored by Mizuho OSI.

The speakers were:

- David W. Polly Jr., MD, chief of spine service, Minneapolis-based University of Minnesota
- Christopher T. Martin, MD, orthopedic and spine surgeon, University of Minnesota
- Kristen Jones, MD, FAANS, neurosurgeon, University of Minnesota
- Jonathan N. Sembrano, MD, orthopedic spine surgeon, University of Minnesota

Here are four quotes from the webinar:

Note: Quotes have been edited for length and clarity.

1. Dr. Polly on the origins of using hinge tables in transforaminal lumbar interbody fusion: "The TLIF surgical technique in the 1990s was to open the disc space up, clean it out, decorticate it, put in a structural body support and bone graft material, and then to restore lordosis. The question then became 'how can we do this better without stressing the screws?' This began an effort that started with the use of a crank Wilson Frame. This was the Wilson Frame that I started using on the original OSI carbon fiber frame table. We would crank it up to induce kyphosis and then crank it down to enhance the lordosis. But you didn't really get true lordosis. We got segmental change. [By using the Wilson Frame], we were able to demonstrate significant contour improvement through the use of the bilateral TLIF. At the time we were using the table to enhance the change. … As we looked at this, it began a discussion with [Mizuho OSI President] Steve Lamb over a decade ago of saying, 'You have a table that's good, but maybe it can be better.' Maybe it could help us distract and compress without having to use pedicle screws to do the distraction and compression. The engineers at Mizuho came up with a motorized hinged carbon fiber frame table. It sounds like it was a challenging engineering feat, but they did it, and then we started to figure out how to use it to optimize the sagittal contour of our patients." 

2. Dr. Martin on using the motorized hinge table in TLIF procedures: "The segmental lordosis for this particular case went from 15 degrees preoperative to 42 degrees postoperative. There was a 27-degree change. It was certainly more than you would expect from a unilateral TLIF based on the available literature, which shows that in a neutral or kyphongenic procedure with bilateral facetectomy and osteotomy closure, it's possible to get a bit of additional lordosis correction. And [so] we found the hinged, motorized operative table is a useful tool for controlling that correction and really dialing in the amount of lordosis that is achieved." 

3. Dr. Jones on performing a controlled pedicle subtraction osteotomy using the hinged motorized operative table: "Using this table allows for a controlled closure of your pedicle subtraction osteotomy site. While you can certainly close a PSO with a lot of different maneuvers and you don't need a motorized table to do so, we've found using the table leads to a very predictable, slow correction without any implant force, which in our view helps reduce the risk of implant loosening over time."

4. Dr. Sembrano on performing multilevel fusion with Smith-Peterson osteotomies: "Multilevel interbody fusion and Smith-Peterson osteotomies can achieve sagittal alignment restoration, and in our patients, we were able to obtain a 30 degree increase in lumbar lordosis and a 14 degree increase in the L4-S1 spine. The use of a hinged table helped facilities sagittal deformity correction. It is not about how much lordosis you can achieve, but rather about hitting your targets. That means you need to define your targets preoperatively. Otherwise, you don't know what you're shooting for." 

View a copy of this webinar here. Learn more about Mizuho OSI here

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