Motion generated in the unstable lumbar spine during hospital bed transfers.

STUDY DESIGN: A parallel group design with repeated measures using a cadaver model was employed. OBJECTIVE: The purpose of this study was to evaluate and compare lumbar spine motion generated in the presence of spinal instabilities during common hospital moves using different transfer techniques. SUMMARY OF BACKGROUND DATA: Up to 25% of spinal cord injuries may occur during initial management of the patient with a compromised spinal column, when multiple transfers between diagnostic locations and operating, recovery and hospital rooms are often required. Few studies have compared methods of moving patients with lumbar spinal column injuries in hospital settings. METHODS: A global instability was created in 3 cadavers at L1 and sensors were attached to T12 and L2. A 3-dimensional electromagnetic tracking system (Liberty, Polhemus Inc) was used to measure flexion, lateral bending, and axial rotation while moving a cadaver from one bed to another to compare 2 transfer techniques used in hospitals: manual transfer and the On3, a motorized lateral transfer device (Hill-Rom, Batesville, IN). RESULTS: Significant increases in lumbar angulations (P<0.05 for all motions) were produced by manual transfers as compared with the On3 device. Manual transfers completed with 6 trained personnel produced 153% more flexion, 92% more axial rotation, and 177% more lateral bending than moves performed by 2 people with the On3 transfer device. CONCLUSIONS: The On3 device reduced motion in the patient with an unstable lumbar spine during hospital bed transfers with fewer personnel.

Motion in the unstable cervical spine: comparison of manual turning and use of the Jackson table in prone positioning.

OBJECT: The purpose of this study was to compare manual maneuvering with the use of a Jackson table when moving patients with cervical spine instability from the supine to the surgically appropriate prone position. METHODS: The range of motion (ROM) of the cervical spine of a fresh cadaver was measured. A ligamentous instability was created at the C5-6 level, and the increased ROM was confirmed. Sensors for an electromagnetic motion analysis device were fixed to the anterior portions of the C-5 and C-6 vertebral bodies (VBs) using machined polyethylene mounts and carbon fiber rods that were inserted into the VBs. The sensors were used to measure cervical flexion, lateral bending, and axial rotation during the two transfer procedures. The cadaver was then moved from the supine position on a hospital bed to the prone position for surgery. The manual technique was performed by four trained individuals who moved the cadaver from the hospital bed while rotating it 180 degrees axially onto the surgical table. In using the Jackson table, the cadaver was moved from the bed to the table in the supine position and then the Jackson table rotated the cadaver to the prone position. The two techniques were tested with and without the use of a collar and were repeated five times. RESULTS: Analysis of the data indicated that when moving a patient into the prone surgical position, the use of a cervical collar and the Jackson table significantly reduced the cervical motion in all angular planes compared with that of manual transfer. CONCLUSIONS: The use of a cervical collar and the Jackson table may reduce the possibility of further spinal cord compromise. Because manual transfers are performed routinely, this warrants further study.

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.

BACKGROUND: The main comorbidities associated with spinal cord injury patients are secondary to immobilization. Kinetic bed therapy is used currently to reduce the complications associated with immobilization, but the effect on the unstable spine has not been quantified. The purpose of this study was to compare the motion in the cervical and thoracolumbar spine when cadavers with spinal instabilities are log rolled (LR) on a standard hospital bed or rotated on a RotoRest kinetic treatment table (KTT). METHODS: Cervical and lumbar instabilities were created surgically in three embalmed cadavers. An electromagnetic tracking device was used to measure the three-dimensional segmental motion generated at C5 to C6 and T12 to L2 during LR and KTT treatments. RESULTS: In both the cervical and lumbar spine, significantly more motion was observed during LR than KTT treatment. CONCLUSIONS: We found that in cadavers with severely unstable cervical spine, rotation using a KTT produced less flexion and lateral bending than the LR. Also, in cadavers with severely unstable lumbar spine, treatment with the KTT produced less axial rotation than the LR. Currently, we think that the best way to immobilize the spine while still allowing therapeutic motion is through the use of a KTT.