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.