Patent Application
20240238142
The present disclosure is directed to devices, systems, and methods for performing surgery on patients. Particular embodiments include methods and apparatuses for securing and supporting a patient on an operating table.
The human spine is comprised of a plurality of components (e.g., vertebral bodies, intervertebral discs, posterior bony structures) which collectively protect the spinal cord and enable the normal motions of flexion (bending forward), extension (bending backwards), lateral bending (bending side to side), and rotation (twisting). These normal physiologic motions may be impeded and/or painful when any number of conditions exists, including but not limited to disc degeneration, trauma, and deformity (e.g., scoliosis). Depending upon the condition, surgical intervention may be required to restore the normal physiologic function of the spine at the affected region.
With a patient placed on an operating table, medical personnel may want to modify the position of the patient before, during or after the surgery, such as by tilting the table to effectuate relative rotation of a patient within the sagittal, coronal, and/or axial planes. But such table movement may cause the patient to roll or otherwise move with respect to the table. Various methods and apparatuses are known to attempt to address this issue, including straps, wraps/tape, bracings, and other elements which attempt to hold portions of the patient (e.g., the hips, shoulders, etc.) in a desired position.
The present disclosure relates to systems, devices, and methods for maintaining a patient in a desired position during treatment procedures such as spinal surgeries.
In one embodiment, a surgical table has one or more board-like structures secured thereto and adapted to hold a patient in a desired position (e.g., supine, prone, lateral) on the table as the table is moved, such as where the table is tilted to effectuate rotation of a patient within the sagittal, coronal, and/or axial planes. The board-like structures may be removably secured to the table, such as via rails (also referred to as beams herein and in the art) which may run (and may even define) the length of the table. Examples of such rails (aka beams) are the rails of a so-called “Jackson table.” The boards/board assemblies may include locking mechanisms to secure the boards/board assemblies to the rails. The locking assemblies may be adapted to allow a user to remove the boards/board assemblies from the rail; to prevent sideways removal of the boards/board assemblies while allowing the boards/board assemblies to slide along the rail; and/or to lock the boards/board assemblies to the rail such that the boards/board assemblies are prevented from sliding along the rails. Some or all elements of the locks may be substantially transparent/translucent to the imaging system, such as by being radiolucent, in order to improve imaging from the imaging system.
The boards may include patient supports, such as padding, etc., on surfaces thereof. The patient supports may be adapted to conform, support, and cushion portions of the patient's body. The patient supports may serve to improve the holding capability of the table and/or board assemblies for holding the patient in the desired position on the table. Patient supports may be permanently secured to the boards. Patient supports may be removably secured to the board(s), for easy removal and/or attachment by a user. Patient supports of different sizes and shapes (e.g., of different length, width, thickness, shapes) and firmness may be provided for a user to select from and to removably apply to the board(s).
The boards may have one or more peg holes on the upper and/or lower surfaces thereof. One or more of the peg holes may pass all the way through the board(s), or may pass only partially through the board(s). The peg holes may be adapted to slidingly receive one or more pegs and/or other devices adapted to be slidingly (and/or removably) inserted into the peg holes. The peg holes and/or pegs may be used to secure one or more accessories to the boards, such as patient supports, covers, mounting/holding devices (such as mounting devices for surgical arms and cameras), etc. Note that individual accessories may be equipped with pegs adapted to be removably slid into the peg holes, and may include locking mechanisms to hold the accessory pegs in the peg holes to thereby hold the accessory to the bed. When secured to the board(s), the accessories may be positioned above, on top of, below, to the side of, or at any other desired position with respect to the board assembly and/or table.
An operating table of an embodiment may have an open frame formed from one or more beams extending lengthwise with respect to the table.
Embodiments include methods of operating on a patient. Such a method may include providing an operating table such as those disclosed above and elsewhere in this application, and such method may include any combination of one or more or all of the following: positioning the patient on the table bed in a desired position; moving at least one of the upper board or lower board; positioning a patient support; confirming proper positioning of the patient for a desired procedure on the patient; and performing the desired procedure on the patient. Moving the at least one of the upper board or lower board may be performed before, during, or after positioning the patient into a desired position on the table bed.
Methods of the embodiments may be methods for treating a spine of the patient, and confirming proper positioning of the patient for a desired procedure on the patient may involve confirming proper spinal alignment of the patient. The system may be adapted to be selectively repositioned in various selected positions with respect to the table bed, and the method may further involve repositioning at least one of the upper or lower boards with respect to the table bed responsive to the positioning of the patient on the table in order to achieve proper positioning of the patient for the desired procedure on the patient.
Embodiments may include systems for performing surgery on a patient, such as where the patient is in a lateral, prone or supine position. Such a system may include an operating table such as those disclosed above and elsewhere in this application, and such a system may include any combination of one or more or all of the following: an imaging system for providing real-time display of one or more portions of the patient's anatomy; and a monitoring system for monitoring one or more patient functions. The imaging system may include an x-ray system, such as an x-ray fluoroscopy system. Such a system may include a C-arm element. The operating table may be adapted to receive the C-arm element around the table frame so that the C-arm element can be moved over and along a substantial length of the table without obstruction in order to image one or more portions of the patient's anatomy as the patient is on the table. One or more portions of the table may be substantially transparent/translucent to the imaging system, such as by being radiolucent, in order to improve imaging from the imaging system.
Other objects, features, and advantages of the present subject matter will become apparent from a consideration of the following descriptions.
It is noted that the drawings of the disclosure are not necessarily to scale. The drawings are intended to depict only typical aspects of the disclosure, and therefore should not be considered as limiting the scope of the disclosure. In the drawings, like numbering represents like elements between the drawings.
A system 100 for treating of a patient 101 is depicted in
Further details of a table 204 and associated elements according to embodiments of the disclosure are depicted in
The table bed frame 206 may include one or more beams 208, which may be formed of carbon fiber and/or may be substantially radiolucent. The table bed frame 206 may be rotatably secured to the support pedestal(s) 202, thus allowing the table bed frame 206 to be rotated about its longitudinal axis 207. Alternatively, or additionally, the table bed frame 206 may be slidingly secured to the support pedestal(s) 202 to permit up and/or down movement of one or both of the respective table ends 209a, 209b, thus varying the height of the head end 209a, foot end 209b, and/or both ends of the table bed frame 206. The securement between the table bed frame 206 and the pedestal(s) 202 may permit the table bed frame 206 to vary in the angle between its longitudinal axis 207 and one or both pedestals.
Although a dual-pedestal table is depicted in
The beams 208 may be adapted to receive attachments thereon. According to embodiments of the current technology, one or more board assemblies secured to the rails/beams 208, such as a chest board assembly 210a and/or a leg board assembly 210b as depicted in
The board assemblies 210a, 210b may be adapted to be releasably secured to the beams 208 and may have a locked configuration wherein each board assembly 210a, 210b is locked to the beam(s) 206 in position at a specific location along the length of the table bed frame 206.
The upper board 314 is selectively movable, e.g., via rotation and/or sliding (lateral or lengthwise), with respect to the lower board 312. For example, the upper board 314 may be rotated about the hub 316 with respect to the lower board 312 by an angle 317, which in the particular depiction is 90 degrees. Note that other angles are also within the scope of the disclosure. Depending on the particular embodiment, the upper board 314 can be rotated through a full 360 degrees with respect to the lower board 312.
The lower board 312 may have one or more rail locks 332, which in the embodiment depicted are positioned at or adjacent the opposing lower board ends 318a, 318b. The rail locks 332 are adapted to releasably secure the lower board 312 to the one or more rails of an operating table frame, such as that depicted in
The lower board 312 may have a hub-engaging hole 334 passing at least partially therethrough, with the hub-engaging hole adapted to receive a rod or other element of the hub 316. The lower board 312 may have one or more lower board peg holes 336 passing at least partially therethrough. One or more of the lower board peg holes 336 may have an opening in the lower board top surface 326, in the lower board bottom surface 328, or both. In the case where one or more of the lower board peg holes 336 pass completely through the lower board 312 from lower board top surface 326 to lower board bottom surface 328. The lower board 312 may have as many peg holes 336 as possible without compromising the strength and/or stiffness of the lower board 312. The lower board peg holes 336 may be adapted to slidingly and/or rotatably (e.g., in screw-like fashion) or otherwise receive an apparatus therein, such as by receiving peg of an attachment. Lower board peg holes 336 may be smooth bored. Lower peg holes 336 may include other elements on the inner surface thereof, such as inward projections or outward notches, which are adapted to engage against corresponding coupling elements of a peg of an attachment. For example, one or more lower board peg holes 336 may include one or more threaded elements adapted to receive a screw element of a peg of an attachment. Lower peg holes may include locks adapted to selectively lock pegs therein.
The upper board 314 has opposing upper board ends 338a, 338b with an overall upper board length 340 therebetween; opposing upper board sides 342a, 342b with an overall upper board width 344 therebetween; and an upper board top surface 346 and upper board bottom surface 348 with an overall upper board thickness 350 therebetween. The upper board 314 may preferably have an upper board hub opening 354, which may pass fully (as depicted) or at least partially through the upper board 314. The upper board hub opening 354 is adapted to engage with the hub and permit rotation
The upper board 314 may have one or more upper board peg holes 352 passing at least partially therethrough. Each of the upper board peg holes 352 may have an opening in the upper board top surface 346, an opening in the upper board bottom surface 348, or an opening in both such surface (in the case where an upper board peg hole 352 passes completely through the upper board 314 from upper board top surface 346 to the upper board bottom surface 348). The upper board 314 may have as many peg holes 352 as possible without reducing the strength and/or stiffness of the upper board 314. The upper board peg holes 352 may be adapted to slidingly and/or rotatably (e.g., in screw-like fashion) or otherwise receive an apparatus therein, such as by receiving a peg or other projecting element of an attachment. Upper board peg holes 352 may be smooth bored. Upper board peg holes 352 may include other elements on the inner surface thereof, such as inward projections and outward notches, which are adapted to engage against corresponding coupling elements of a peg of an attachment. For example, one or more upper board peg holes 352 may include one or more threaded elements adapted to receive a screw element of a peg of an attachment. Upper board peg holes may include locks adapted to selectively lock pegs therein.
The lower board 312 and/or upper board 314 of a board assembly 310 may have sufficient strength, alone or in combination with other board assemblies secured to the bed frame, to support the weight of a patient secured thereto. The lower board 312 and/or upper board 314 of a board assembly 310 may have sufficient rigidity to support the weight of a patient secured thereto without noticeable deformation.
Note that the peg holes 336 of the lower board 312 may arranged in a pattern which matches, in peg spacing, peg positioning, and/or peg hole size, a pattern of the peg holes 352 of the upper board 314.
The hub 316 of the particular embodiment may include a rod 360 having a length 361 and a diameter/width 363, as depicted in
The hub 316 is depicted in greater detail in
Dimensions of elements of a board assembly according to embodiments depends on the particular application. For example, a lower board may preferably have sufficient length to extend between opposing rails/beams of a Jackson table frame. An upper board may preferably have sufficient length and width to provide sufficient surface space for proper positioning of any patient supports and/or other attachments on the upper board.
Other hubs, including locking hubs, are also within the scope of the embodiments. For example, as depicted in greater detail in
A locking hub 416 may be adapted to releasably hold an upper board 414 at a particular position with respect to a lower board 412. For example, the hub 416 may have an unlocked configuration wherein the upper board 414 is rotatably and/or slidingly and/or laterally movable with respect to the lower board 412, and a locked configuration wherein the upper board 414 is prevented from the previously-allowed movement with respect to the lower board 412 (e.g., rotatably and/or slidingly and/or laterally movement) of the unlocked configuration.
The locking hub 416 depicted has a central rod 460 secured at one end to an upper plate 462, with rod 460 slidingly passing through a hole in a lower plate 464 such that an opposing end of the rod 460 is positioned on an opposite side of the lower plate 464 from the upper plate 462. A rocker 466 is rotatably secured at the opposing end of the rod 460. A handle 468 is secured to the rocker 466, with the handle 468 adapted to be moved through an angle 470 which in turn rotates the rocker 466. The upper plate is engaged against or otherwise secured to the upper board (e.g., engaged against a top surface of the upper board), while the lower plate is engaged against or otherwise secured to the lower board (e.g., engaged against a bottom surface of the lower board). With the handle in the unlocked configuration, such as that depicted in
Note that upper plate 462 in the embodiments depicted is on (e.g., flush with) the upper board top surface 446, and has sufficient dimensions (e.g., diameter, width, etc.) to prevent its accidental passage through the upper board rod hole 454. Similarly, lower plate 464 in the embodiments depicted is on (e.g., flush with) the lower board bottom surface 428, and has sufficient dimensions (e.g., diameter, width, etc.) to prevent its accidental passage through the lower board rod hole 434. Note that upper plate 462 could be secured (e.g., fixedly or rotationally) to (e.g., on or within) upper board 414, depending on the embodiments. Similarly, lower plate 464 could be secured (e.g., fixedly or rotationally) to (e.g., on or within) lower board 412, depending on the embodiments.
The locking hub or other locking mechanism may be adapted to be selectively activated by a user to be moved between the locked configuration and the unlocked configuration and vice-versa. The user can move the lock to the unlocked configuration; then rotate and/or slide (e.g., lengthwise and/or laterally) the upper board to reposition the upper board with respect to the lower board. Once a desired position of the upper board is achieved, the user can engage the lock to the locked configuration, thereby locking the upper board in the desired position. Note that repositioning of the boards with respect to each other can occur prior to positioning of the patient on the table; concurrent with positioning of the patient on the table; and/or after positioning of the patient on the table (e.g., during a surgical procedure). Multiple positioning and repositioning of the boards and/or patient can occur before and/or during and/or after a procedure.
Note that other hubs and/or locking mechanisms are within the scope of embodiments. For example, as depicted in
Other configurations of board-to-board locks, such as screw-like attachments between boards, peg-like engaging elements extending between boards, etc., are also within the scope of various embodiments. Also, board-to-board locks according to the embodiments may have different configurations where some degrees of movement are permitted while others are prevented. For example, as in the embodiment of
Board-to-board locks may be adapted to permit relative movement of boards which is confined to a plane parallel to the plane of an adjacent board. For example, a board may be rotated and/or slid (lengthwise and/or laterally) in a plane parallel to the top or bottom surface of the adjacent board.
Boards of the assemblies may include elements adapted to engage and cooperate with the lock to control (e.g., guide/direct) the rotating and/or sliding and/or lateral movement of the upper board. For example, as depicted in
As depicted in
A simple slot opening 554c may be positioned non-parallel to the length of the upper board 514c, such as at 90 degrees to the length of the board 514c as depicted in
As depicted in
In the embodiments of
Patient supports (e.g., cushioning) may be secured to the top board and/or bottom board of a board assembly, such as at the top surfaces of the board(s). Such patient supports may preferably be adapted to engage against a patient and to provide a comfortable and supportive surface against which portions of the patient's body (e.g., the head, side, hips, back, shoulders, stomach, arms, legs, etc.) can engage against and/or be secured. For example, as depicted in
As shown in
One or more patient supports 1172, which may have different sizes and/or shapes, may be secured to a board assembly 1110 at desired locations, as depicted in
Positioning and securing of a patient on a table of the disclosure may include: securing one or more board assemblies to an operating table, such as a so-called “Jackson table” or other table having rails/beams to which a board assembly is adapted to be attached (which may include securing a rail locking element of a lower board to one or more of the rails/beams); securing a patient support to the board assembly, such as to the upper and/or lower boards thereof; and positioning the patient on the table with one or more patient anatomical features engaging against the one or more patient supports. Positioning and securing may also include securing the patient to the table/board assembly vie one or more straps which extend around the patient and hold the patient against one or more of the patient supports.
As depicted in
Boards and board assemblies of embodiments may have varying dimensions and/or shapes, depending on the particular application. For example, a board can be a rounded shape, such as an oval or circle.
Boards do not have to be simple rectangles. For example, a board can be a rounded shape, such as an oval or circle.
Boards may include cutouts, such as cutouts adapted to accommodate one or more patient body portions, e.g., an arm/elbow, a shoulder, a hip, a leg, etc. For example, a cutout may be included into/through which a portion of the patient (e.g., an arm) could be advanced when positioning the patient on the board assembly.
A board assembly 1410 may be adapted for tilting of an upper board 1414 with respect to a lower board 1412 by a desired angle 1417, as shown in
Other mechanisms for achieving desired tilting of an upper board are also within the scope of the embodiments. For example, an upper board could have a hinged upper portion which could tilt upward, via the hinge, at an angle away from a lower portion of the upper board. An electric motor and associated gears (not shown) could be used to move the upper board with respect to the lower board, including tilting movement (and/or rotational and/or sliding movement).
An operating table 1504 may have one or more board assemblies secured thereto, such as chest board assembly 1510a and leg board assembly 1510b, as depicted in
Board assemblies 1510a, 1510b may be adapted for lateral (sideways) movement of the upper boards 1514a, 1514b with respect to the bed frame 1506, as depicted in
As depicted in
In the example of
In the example of
Note that the direction and extent of rotation of respective upper boards can be varied according to the particular application, including the patient position desired by a surgeon or other user(s).
Note that rotation of the upper boards could be combined with sliding of the upper boards, including lateral and/or lengthwise sliding.
As discussed previously with respect to
Both the chest upper board 1714a and the leg upper board 1714b could be tilted, as shown in
Note that tilting of the upper boards could be combined with rotation and/or sliding of the upper boards, including lateral and/or lengthwise sliding.
Various attachments may be used with the embodiments, such as attachments for engaging and/or supporting element of the patient's body, such as the head, back, shoulder, arms, legs, etc. Other attachments are also within the scope of the disclosure, including [cameras and/or mounts, and surgical support arms, etc. Note that multiple attachments may be used with a single board assembly, including any combination of the above examples of attachments.
Note that each element of each embodiment and its respective elements disclosed herein can be used with any other embodiment and its respective elements disclosed herein.
All dimensions listed are by way of example, and devices according to the disclosure may have dimensions outside those specific values and ranges. The dimensions and shape of the device and its elements depend on the particular application.
Unless otherwise noted, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. In order to facilitate review of the various embodiments of the disclosure, the following explanation of terms is provided:
The singular terms “a”, “an”, and “the” include plural referents unless context clearly indicates otherwise. The term “or” refers to a single element of stated alternative elements or a combination of two or more elements, unless context clearly indicates otherwise.
The term “includes” means “comprises.” For example, a device that includes or comprises A and B contains A and B, but may optionally contain C or other components other than A and B. Moreover, a device that includes or comprises A or B may contain A or B or A and B, and optionally one or more other components, such as C.
The term “subject” refers to both human and other animal subjects. In certain embodiments, the subject is a human or other mammal, such as a primate, cat, dog, cow, horse, rodent, sheep, goat, or pig. In a particular example, the subject is a human patient.
Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present disclosure, suitable methods and materials are described below. In case of conflict, the present specification, including terms, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting. The descriptions of embodiments of the technology are not intended to be exhaustive or to limit the technology to the precise form disclosed above. Where the context permits, singular or plural terms may also include the plural or singular term, respectively. Although specific embodiments of, and examples for, the technology are described above for illustrative purposes, various equivalent modifications are possible within the scope of the technology, as those skilled in the relevant art will recognize. For example, while steps are presented in a given order, alternative embodiments may perform steps in a different order. The various embodiments described herein may also be combined to provide further embodiments.
As used herein, the terms “generally,” “substantially,” “about,” and similar terms are used as terms of approximation and not as terms of degree, and are intended to account for the inherent variations in measured or calculated values that would be recognized by those of ordinary skill in the art.
Moreover, unless the word “or” is expressly limited to mean only a single item exclusive from the other items in reference to a list of two or more items, then the use of “or” in such a list is to be interpreted as including (a) any single item in the list, (b) all of the items in the list, or (c) any combination of the items in the list. Additionally, the term “comprising” is used throughout to mean including at least the recited feature(s) such that any greater number of the same feature and/or additional types of other features are not precluded. It will also be appreciated that specific embodiments have been described herein for purposes of illustration, but that various modifications may be made without deviating from the technology. Further, while advantages associated with certain embodiments of the technology have been described in the context of those embodiments, other embodiments may also exhibit such advantages, and not all embodiments need necessarily exhibit such advantages to fall within the scope of the technology. Accordingly, the disclosure and associated technology can encompass other embodiments not expressly shown or described herein.
In view of the many possible embodiments to which the principles of the disclosed technology may be applied, it should be recognized that the illustrated embodiments are only examples of the disclosure and associated technology and should not be taken as limiting the scope of the technology. Rather, the scope of the technology is defined by the following claims. We therefore claim all that comes within the scope and spirit of these claims.
The present application claims priority to U.S. Provisional Patent Application No. 63/236,036, filed on Aug. 23, 2021, which is incorporated by reference as though fully set forth herein.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US22/74967 | 8/15/2022 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 63236036 | Aug 2021 | US |
