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Comparison of Thoracolumbar Motion Produced by Manual and Jackson-Table-Turning MethodsStudy of a Cadaveric Instability Model
Christian P. DiPaola, MD1; Matthew J. DiPaola, MD2; Bryan P. Conrad, MEng3; MaryBeth Horodyski, EdD3; Gianluca Del Rossi, PhD, ATC4; Andrew Sawers, MS1; Glenn R. RechtineII, MD1
1 Departments of Orthopaedics (C.P.D. and G.R.R.) and Orthotics and Prosthetics (A.S.), University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642. E-mail address for G.R. Rechtine II: glenn_rechtine@urmc.rochester.edu
2 Department of Orthopaedic Surgery, Thomas Jefferson University Medical Center, 1015 Walnut Street, Suite 801, Philadelphia, PA 19107
3 Department of Orthopaedics, University of Florida, Box 112727, Gainesville, FL 32611-2727
4 Department of Orthopaedics and Sports Medicine, University of South Florida, 3500 East Fletcher, #511, Tampa, FL 33613
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Operating Committee on Standards for Athletic Equipment (NOCSAE). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the University of Rochester Medical Center, Rochester, NY

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Aug 01;90(8):1698-1704. doi: 10.2106/JBJS.G.00818
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Background: Patients who have sustained a spinal cord injury remain at risk for further neurologic deterioration until the spine is adequately stabilized. To our knowledge, no study has previously addressed the effects of different bed-to-operating room table transfer techniques on thoracolumbar spinal motion in an instability model. We hypothesized that the conventional logroll technique used to transfer patients from a supine position to a prone position on the operating room table has the potential to confer significantly more motion to the unstable thoracolumbar spine than the Jackson technique.

Methods: Three-column instability was surgically created at the L1 level in seven cadavers. Two protocols were tested. The manual technique entailed performing a standard logroll of a supine cadaver to a prone position on an operating room Jackson table. The Jackson technique involved sliding the supine cadaver to the Jackson table, securing it to the table, and then rotating it into a prone position. An electromagnetic tracking device measured motion—i.e., angular motion (flexion-extension, lateral bending, and axial rotation) and linear translation (axial, medial-lateral, and anterior-posterior) between T12 and L2.

Results: The logroll technique created significantly more motion than the Jackson technique as measured with all six parameters. Manual logroll transfers produced an average of 13.8° to 18.1° of maximum angular displacement and 16.6 to 28.3 mm of maximum linear translation. The Jackson technique resulted in an average of 3.1° to 5.8° of maximum angular displacement (p < 0.001) and 4.0 to 10.0 mm of maximum linear translation (p < 0.05).

Conclusions: Compared with the logroll, the Jackson-table transfer method provides superior immobilization of an unstable thoracolumbar spine during transfer of supine cadavers to a prone position on the operating room table.

Clinical Relevance: This study addresses in-hospital patient safety. Performing the Jackson turn requires approximately half as many people as required for a manual logroll. This study suggests that the Jackson technique should be considered for supine-to-prone transfer of patients with known or suspected instability of the thoracolumbar spine.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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