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A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
The risks and dangers of complex spine procedures are significant, so surgeons must work with specially designed tables that give them the access, visibility, versatility, positioning and control they require to treat patients safely and effectively. If you're expanding your facility's spinal offerings or thinking about bringing new cases into your outpatient ORs, you'll need tables made specifically for this growing specialty.
- Versatility is key. Most spine tables used today are based on the Jackson table design. The nice thing about the Jackson table is it can be used for every operation a spine surgeon performs. For spine procedures taking place in the outpatient setting, you want to invest in one table on which you can swap different attachments and accessories that are easy to store and don't take up a lot of space.
- A solid base. Leading spine tables have radiolucent surfaces to accommodate intraoperative imaging and a base that doesn't need to be changed, regardless of the types of procedures surgeons perform. This certainty about the table's footprint is well-suited to space-conscious surgery centers, where the goal is to keep OR set-ups as uniform and cookie-cutter as possible.
Because the uniform bases of the spine table always remains a constant, no matter what top is being used, it provides predictability for both staff and administration. The table never becomes a limiting factor in terms of the surgeries you can perform, because you know exactly how much floor space the table will occupy. This uniformity also helps turnover times, because you never have to move different tables in and out of the same OR to accommodate various types of spine surgeries.
When tables have a uniform base, moving around the OR, maneuvering equipment around the table and storing equipment underneath the surface becomes much more familiar and easier, which is important in spine surgeries. For example, when we need to take an intraoperative X-ray, we can easily maneuver fluoroscopy equipment around the table because the space underneath and around the surface is generous.
- Interchangeable tops. Spine tables come with different attachments that allow you to reconfigure the surface for various procedures and patient positions. We can extend the length of our Jackson table as needed, for example, although we've rarely had to make that adjustment. The tallest patient I've had on the table was six-foot-seven. He fit on the standard configuration, but we could have extended the length of the table four to five inches in each direction.
The ability to reconfigure the top of the table with minimum fuss is key.
The ability to reconfigure the top of the table with minimum fuss is key. I work with a flat top for cases such as anterior cervical or lumbar fusion procedures where the patient is lying flat on their back. If a patient is placed in the prone position, we'll often add a Wilson frame, which provides padding for the patient's face and chest, and naturally positions them in a neutral posture that enables me to access the posterior part of the spine. We also use a configuration I call "Jackson with four posts," which involves attaching posts that make contact only with the patient's thighs, pelvis and chest, leaving the abdomen entirely free. The positioning of the posts changes the curvature of the patient's spine, which can be helpful when we're trying to reconstruct its alignment. By simply changing the position of the posts, the task becomes a bit easier.
Spine tables are fairly mature pieces of equipment, but there's at least one area in which they can improve. I perform a lot of minimally invasive surgeries that involve the use of tubular retractors, the arms of which connect to the table to ensure the retractor stays exactly where I want it while it's inside the patient. But the area where the arm connects to my table is through a holder that wasn't meant for a Jackson table. We end up jury-rigging the set-up, but I'd like to see manufacturers expand my options for how to attach these arms to tables. OSM
Hillrom
Allen Advance Table
This table, designed for complex spine procedures, can accommodate patients weighing up to 600 pounds. The company notes that the table, which offers radiolucency through its entire working length, rotates through 360 ? to make it easy to switch anesthetized patients between supine and prone positions. Features designed with safety and convenience in mind include central locking wheel castors that help staff members maneuver the table around the OR and numbered H-Brackets for improved communication among staff members who are attaching varying tabletops to the base. The unique H-bracket design also ensures the surface won't fall to the floor if the wrong pin is accidentally pulled when patients are being repositioned.
Hillrom
Carbon Spine OR Tabletop
Here's an example of a specialty tabletop for spine surgery that might be attractive to multispecialty surgery centers who use Hillrom's TS 7500 OR Table, which is designed to accommodate a wide variety of surgical disciplines. The Carbon Spine OR Tabletop, designed for complex spine surgery procedures, features a low profile and open foot room to improve access to the patient. Hillrom also offers related pads, components and accessories that offer flexible positioning for the various anatomies of spine patients.
Mizuho OSI
ProAxis Spinal Surgery Table
Mizuho, which launched an advanced spine surgery table in 2013, highlights this table's ability to support OR efficiency and simplify workflow. Its hinged radiolucent frame is said to provide superior surgical access, precision and flexibility to facilitate a wide range of simple and complex spine and imaging procedures, especially those requiring intraoperative flexion and extension of the lumbar spine. Designed for prone, lateral and supine positions, the table can be adjusted in increments as small as one degree and offers two position memory settings.
Mizuho OSI
Trios Surgical Table System
As this modular table's name suggests, Trios isn't purely a spine table. It can be configured with different tops to serve three specialties: spine, imaging and orthopedic trauma. The latest version of the table promises enhanced safety features, improved setup workflows and increased weight capacity. The ability to transform the table's use as needed is aided by its dual column platform, which is designed for interchangeable patient positioning. Featuring single-push electronic floor locks and a 180 ? patient rotation mechanism, its mounting interface keeps the tabletop locked in place. Each top can be purchased individually or as part of a system. The spinal top's open spine frame reduces vena cava compression, minimizes epidural venous bleeding and improves visualization at the surgical site, according to Mizuho. Note that this top handles only the prone position for spine procedures.
Schaerer Medical USA
7300 Carbon Spine Frame Table
Schaerer Medical points to versatility as this table's main advantage — the ability for a single surface to be reconfigured as several different specialty tables. The 7300 can be used for spinal cases requiring an open-frame, four-post table, but it can also be used for lateral spine cases, as well as orthopedics or pain management cases — and even general surgery. Schaerer Medical says the table can be cantilevered lower than competing tables, enabling surgeons to sit while operating. For anesthesia providers, there's no column at the head end of the table, enabling easier airway access and patient monitoring. The entire frame is radiolucent, and a motorized joint moves the tabletop to a flex or reflex position.
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