Abstract
Purpose
Hyperextension-distraction type injury of the thoracolumbar spine is an unstable fracture pattern that generally necessitates surgical stabilization by posterior instrumentation. Care must be taken when positioning these patients from supine to prone due to the unstable nature of their injury. The study objectives were (1) to describe a novel modification of the Jackson table turn technique, which may be safer and more effective than the conventional log-roll method and traditional Jackson table technique for positioning patients with hyperextension-distraction injuries of the thoracolumbar spine from supine to prone in the operating room and (2) to present two cases in which this technique was successfully performed.
Methods
Two patients were carefully positioned from supine to prone by our modification of the Jackson table turn technique, which utilizes a Wilson frame sandwiched between two flat-top Jackson frames. Case 1: a 65-year-old female presented status-post motor vehicle collision with a T9–T10 extension-distraction injury, requiring T7–T12 posterior spinal instrumented fusion (PSIF). Case 2: a 72-year-old female presented status-post motor vehicle collision with a T9–T10 extension-distraction injury and an unstable L1 burst fracture, requiring T7–L2 PSIF.
Results
Both patients remained hemodynamically stable and neurologically intact throughout positioning and postoperatively.
Conclusions
This technique is safe and effective for positioning patients with hyperextension-distraction type injuries of the thoracolumbar spine from supine to prone in the operating room and may be superior to conventional methods.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
References
Burke DC (1971) Hyperextension injuries of the spine. J Bone Joint Surg Br 53(1):3–12
Vaccaro AR, Oner C, Kepler CK et al (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine 38(23):2028–2037. https://doi.org/10.1097/BRS.0b013e3182a8a381
Rampersaud YR (2013) Thoracolumbar distraction extension injuries. In: Anderson GD, Vaccaro AR (eds) Decision making in spinal care. Thieme Medical Publishers, Inc., Stuttgart, pp 117–119
Toscano J (1988) Prevention of neurological deterioration before admission to a spinal cord injury unit. Paraplegia 26(3):143–150. https://doi.org/10.1038/sc.1988.23
Gertzbein SD (1994) Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital. Spine 19:1723–1725 PMID: 7973966
Rechtine GR, Del Rossi G, Conrad BP, Horodyski M (2004) Motion generated in the unstable spine during hospital bed transfers. J Trauma 57:609–612 PMID:15454810
Levi AD, Hurlbert RJ, Anderson P et al (2006) Neurologic deterioration secondary to unrecognized spinal instability following trauma—a multicenter study. Spine 31:451–458. https://doi.org/10.1097/01.brs.0000199927.78531.b5
Todd NV, Skinner D, Wilson-MacDonald J (2015) Secondary neurological deterioration in traumatic spinal injury: data from medicolegal cases. Bone Joint J 97-B(4):527–531. https://doi.org/10.1302/0301-620x.97b4.34328
McGuire RA, Neville S, Green BA et al (1987) Spinal instability and the log-rolling maneuver. J Trauma 27(5):525–531 PMID: 3573109
Del Rossi G, Horodyski M, Conrad BP et al (2008) Transferring patients with thoracolumbar spinal instability: are there alternatives to the log roll maneuver? Spine 33(14):1611–1615. https://doi.org/10.1097/BRS.0b013e3181788683
Suter RE, Tighe TV, Sartori J et al (1992) Thoraco-lumbar spinal instability during variations of the log-roll maneuver. Prehospital Disaster Med 7(2):133–138. https://doi.org/10.1017/S1049023X00039364
Rechtine GR, Conrad BP, Bearden BG et al (2007) Biomechanical analysis of cervical and thoracolumbar spine motion in intact and partially and completely unstable cadaver spine models with kinetic bed therapy or traditional log roll. J Trauma 62(2):383–388. https://doi.org/10.1097/01.ta.0000225924.12465.e6
Prasarn ML, Zhou H, Dubose D et al (2012) Total motion generated in the unstable thoracolumbar spine during management of the typical trauma patient: a comparison of methods in a cadaver model. J Neurosurg Spine 16:504–508. https://doi.org/10.3171/2012.2.SPINE11621
Bearden BG, Conrad BP, Horodyski M, Rechtine GR (2007) Motion in the unstable cervical spine: comparison of manual turning and use of the Jackson table in prone positioning. J Neurosurg Spine 7:161–164. https://doi.org/10.3171/SPI-07/08/161
DiPaola MJ, DiPaola C, Conrad BP, Horodyski MB, Del Rossi G, Sawers A, Bloch D, Rechtine G (2007) Cervical spine motion in manual vs. Jackson table turning methods in a cadaveric global instability model. J Spinal Disord Tech 21(4):273–280. https://doi.org/10.1097/bsd.0b013e31811513a4
DiPaola CP, DiPaola MJ, Conrad BP et al (2008) Comparison of thoracolumbar motion produced by manual and Jackson-table-turning methods: study of a cadaveric instability model. J Bone Joint Surg Am 90:1698–1704. https://doi.org/10.2106/JBJS.G.00818
Westerveld LA, Verlaan JJ, Oner FC (2009) Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 18(2):145–156. https://doi.org/10.1007/s00586-008-0764-0
Caron T, Bransford R, Nguyen Q et al (2010) Spine fractures in patients with ankylosing spinal disorders. Spine 35(11):E458–E464. https://doi.org/10.1097/BRS.0b013e3181cc764f
Lindtner RA et al (2017) Fracture reduction by postoperative mobilization for the treatment of hyperextension injuries of the thoracolumbar spine in patients with ankylosing spinal disorders. Arch Orthop Trauma Surg 137:531–541. https://doi.org/10.1007/s00402-017-2653-7
Rustagi T, Drazin D, Oner C et al (2017) Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes. J Orthop Trauma 31(9 Supp):S57–S74. https://doi.org/10.1097/BOT.0000000000000953
Schiefer TK, Milligan BD, Bracken CD et al (2015) In-hospital neurologic deterioration following fractures of the ankylosed spine: a single-institution experience. World Neurosurg 83(5):775–783. https://doi.org/10.1016/j.wneu.2014.12.041
Teunissen FR, Verbeek BM, Cha TD et al (2017) Spinal cord injury after traumatic spine fracture in patients with ankylosing spinal disorders. J Neurosurg Spine 27(6):709–716. https://doi.org/10.3171/2017.5.SPINE1722
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Moon, A.S., Cignetti, C.A., Isbell, J.A. et al. Traumatic hyperextension-distraction injuries of the thoracolumbar spine: a technical note on surgical positioning. Eur Spine J 28, 1113–1120 (2019). https://doi.org/10.1007/s00586-019-05917-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-019-05917-2