Utilization of a mechanical hinge-powered operative table in thoracic spinal cord decompression and fusion: a report...

The current case study identifies an alternative use of the ProAxis® Table by Mizuho | OSI (ProAxis) during thoracic cord decompression prior to final stabilization. We present two cases of thoracic cord compression with progressive neurologic decline associated with patient positioning during advanced imaging acquisition and intraoperatively, with a solution to intraoperative neurologic deterioration.

Case 1: a 59-year-old female with history of T11-pelvis posterior instrumented fusion for deformity presented with adjacent segment disease, excessive segmental kyphosis, and herniated disc at T10-T11. The patient reported severe midback pain and progressive neurologic deterioration with weakness in bilateral lower extremities (BLE). The patient was indicated for thoracic decompression and fusion extension. Preoperative somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) were intact. Upon prone positioning on an open Jackson frame, SSEPs were lost in BLE. A Stagnara Wake Up test with the patient positioned in flexion on the hospital stretcher confirmed acute neurologic injury with rapid functional recovery. The patient was ultimately treated with thoracic laminectomy, T9-T11, and extension of fusion to T4 on a ProAxis with decompression performed in 28-degrees flexion and subsequent table flattening to neutral over the course of the procedure. No neuromonitoring abnormalities were identified. The patient awoke with full motor strength. Case 2: a 68-year-old male with history of metastatic prostate cancer presented with high grade epidural spinal cord compression resulting from metastatic tumor to T6-T7 with acute American Spinal Injury Association (ASIA) B neurologic grade after a fall from standing height. The patient was indicated for emergent thoracic decompression and fusion. Upon advanced imaging acquisition, the patients' neurologic function further deteriorated. Intraoperatively the patient was positioned prone in flexion on a ProAxis at baseline 20-degrees thoracic kyphosis. No neuromonitoring changes were appreciated throughout the procedure. The patient's motor strength improved throughout his hospitalization with near full motor strength recovery in his BLE at final follow-up.

We present two cases in which the ProAxis was used to maintain patient alignment during thoracic decompression at a degree associated with preoperative neurologic function with resultant restoration of neurologic function in the postoperative period.