Frame for positioning the prone position of a patient during surgery

Abstract

To provide a frame for positioning a prone position of a patient during surgery.SOLUTION: An accessory for attachment to a surgical table supporting at least a portion of a patient's body, the accessory including at least one support structure having an adjustable length, a frame extending from a proximal end to a distal end, the distal end of the frame configured to be rotatably coupled to the surgical table, and a multi-axis joint mounted on the at least one support structure rotatably coupled to the proximal end of the frame, the multi-axis joint having at least a first rotational degree of freedom about a tilt axis of the frame and a second rotational degree of freedom about an axis orthogonal to the tilt axis of the frame.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present disclosure relates to a frame that can be removably attached to a surgical table to support a patient's body parts during surgery. More particularly, the present disclosure relates to a frame that can be removably attached to a surgical table and configured to support a patient's arms, torso parts, head and legs, or other body parts during surgery, such as spinal surgery. [Background technology]

[0002] Standard operating tables or beds, also known as surgical beds or operating room tables, have a base with surgical accessory rails, support columns, and patient support sections that are moved by electric linear or hydraulic actuators to position the patient as desired during a surgical procedure. Operating tables may be height-adjustable. One or more patient support sections can pivot or tilt relative to the operating table base. These patient support sections may pivot or tilt together by the same amount or degree relative to the operating table base. The patient support sections of these standard operating tables may have metal frames, which may also include other metal elements that can interfere with a clinician's ability to obtain high-resolution fluoroscopic images of the patient during surgery. These types of high-resolution images can be important to ensure the safe and effective implantation of screws, rods, replacement discs, or other necessary hardware near nerves in the spine or neck. Therefore, many standard operating tables are not suitable for spinal or other orthopedic procedures.

[0003] Specialized operating tables have been developed for spinal surgery. For example, the "Jackson" table, "Trios" table, "Andrew" table, and Allen Advance™ table are designed specifically for spinal surgery. Examples of "Jackson" tables can be found in U.S. Pat. Nos. 5,629,997, ...

[0004] Current technology includes substantially radiolucent table extensions that are removably attached to a surgical table that can support a patient during spinal or other surgical procedures during which X-ray or fluoroscopic images of the patient's upper body are taken. See, for example, U.S. Patent Nos. 5,629,999; 5,629,999; 5,629,999; 5,629,999; and 5,629,999. Each of the devices disclosed in the above-listed patents includes a table surface or similar structure underlying the patient that can be removably attached to the underlying surgical table. In some surgical procedures in which the patient is in a prone position, it is desirable for the patient's abdomen to hang downward without obstruction so that it is not supported by the underlying table surface. This allows blood to pool in the abdomen and away from the surgical site, i.e., the spinal column or cervical spine. Therefore, some table extensions with such table surfaces or panels may not be suitable for some spinal surgical procedures. Additionally, many known table extensions that connect to an associated operating table do not allow the extension to pivot relative to the operating table in a manner that would allow the patient's torso to bend a sufficient amount to place the lumbar region of the patient's spine in a more lordotic (i.e., more arched) or kyphosis (i.e., flatter or hunched) position than when the patient is simply lying flat in a recumbent position with the lumbar region of the patient's spine in its natural arched position.

[0005] Attempts have been made to address the above issues with radiographic table extensions, in which the radiographic table pivots at an attachment point that removably couples to the operating table. These table extensions generally include a linear attachment frame with radiographic spars that can be removably attached to the operating table. Two radiographic spars are linear in cross section and spaced parallel to each other, and a support element connects the spars to form a linear frame. These frames are equipped with patient support devices with various cushions that can be removably attached to support the patient. These patient support devices include devices for chest support and devices for arm and leg support, all of which can move or adjust the spars up and down to facilitate safe positioning of the patient. These patient support devices have latches that can be in either a locked or unlocked position. They are designed to prevent compression ulcers, nerve damage, and other problems caused by the patient being in a supine position during long spinal procedures. The patient support devices must not move relative to the frame during surgery. To move or adjust their position, they must be placed in the unlocked position. For example, when unlocked, a clinician can adjust their location on the spar to properly support the patient, then lock them into place once the patient is in the desired position. One example of such a frame with a patient support device is illustrated by the "Allen Flexible Frame" in U.S. Patent No. 5,629,499. This frame has a "U"-shaped base to which the attached frame remains fixed to the floor unless tilted, at which point its casters contact the ground and allow it to rotate and move from place to place. A first end of the rectangular, radiolucent frame is removably attached to the operating table, while a second end of the frame is attached to a support structure that can be extended upward relative to the floor and retracted relative to the floor via a manual jackscrew. A ball-and-socket joint is present in the support structure, and its lower end is attached to the support base. The support structure is attached to the first end of the frame at its upper end.The ball-and-socket joint allows the support structure to pivot around the support base, while the first end of the frame can tilt forward, backward, and sideways relative to the support base or floor. The second end of the frame can pivot relative to the operating table using a distal pivot member. This distal pivot member of the frame can be removably coupled to the distal end of the operating table. The base is fixed in this design. When articulated, the dependent movement of the frame relative to the support structure, the support structure relative to the frame, the support structure relative to the operating table, and the frame relative to the operating table allows for positioning of the patient's decubitus position in various positions. This facilitates imaging of the patient's torso or spine while allowing the clinician access to the surgical site. Yet another attempt by ISO Medical of Japan involves a fixed top distal end of the frame and a wheeled base that can move about an axis defined by a vertical support column, which is attached at its lower end to the wheeled base, thereby securing the frame to the upper end of the support column.

[0006] Both of the above frames have two pivotal rotation axes, one at the first end of the frame and one at the second end of the frame, but can also diverge at the base and move about or around an axis generally perpendicular to the floor. More specifically, these designs: a. rotating and tilting the first end of the frame about an axis generally parallel to the floor and generally perpendicular to the support structure; b. bifurcating a first end of the frame coupled to the support structure and moving the first end of the frame about an axis generally perpendicular to the spar of the frame; c. The second end of the frame can be tilted upward or downward about an axis bifurcating the proximal pivot member, to which the frame and the surgical table are removably coupled.

[0007] The patient support devices on the above-described frames support a portion of the patient's body and are configured to fit snugly and closely over the spar of the frame. These patient support devices have latches that, while in a first position, allow the device to be moved up or down on the spar to position the device as desired. Conversely, when the latch is in a second position, the latch clamps the patient support device in place, thus preventing unexpected movement of the device relative to the frame during the procedure and / or when the frame is articulated. It is important that these patient support devices remain in place and do not move relative to the frame during surgery.

[0008] One drawback with the above frame design is that as the support structure moves in space around its base (while the top remains fixed) or its top (while the base remains fixed) in response to articulation of the operating table, the frame is subjected to twisting and bending forces (torsion) that distort the spars of the frame, causing the cross sections of both the spars and the frame to lose their rectangular shape and potentially damaging or destroying the spars. These bending and twisting forces are the result of a mismatch between the frame's freedom of movement and the freedom of movement of the operating table to which it is removably attached.

[0009] These temporary changes in the geometry of the spar members and / or frame can cause the patient support device (formed to fit snugly over the spar) to unlatch, thereby allowing uncontrolled movement relative to the frame during surgery. This loss of the rectangular shape of the spar can also cause the patient support device to pull away from the frame. Because uncontrolled patient movement during spinal surgery is extremely dangerous, such uncontrolled movement and / or pulling away of these patient support devices represents a clinical hazard. Additionally, with current technology, frames are folded and stored on their bases, but the spars are too long to fit into the bases or into the storage hooks of the bases without the spars having adjustment channels that allow the spars to move outward from the support elements to which they are attached. Additionally, these frames may require the removal of any patient support device attached to the frame before storing the frame in an unused position. This removal of the patient support device requires an extra step when the clinician wishes to store the attached frame on the base. [Prior art documents] [Patent documents]

[0010] [Patent Document 1] U.S. Patent No. 5,088,706 [Patent Document 2] U.S. Patent No. 5,131,106 [Patent Document 3] U.S. Patent No. 5,613,254 [Patent Document 4] U.S. Patent No. 6,260,220 [Patent Document 5] U.S. Patent No. 5,444,882 [Patent Document 6] US Patent Application Publication No. 2017 / 0354563A1 [Patent Document 7] U.S. Patent No. 4,995,067 [Patent Document 8] U.S. Patent No. 5,758,374 [Patent Document 9] U.S. Patent No. 6,003,174 [Patent Document 10] U.S. Patent No. 6,584,630 [Patent Document 11] U.S. Patent No. 6,813,788 [Patent Document 12] U.S. Patent No. 7,699,262 B2 Summary of the Invention [Problem to be solved by the invention]

[0011] Due to the described shortcomings in the current technology, there is a need for a surgical frame for supine or spinal surgery whose degrees of freedom of movement match those of the surgical table to which it is removably coupled. This matching of degrees of freedom of movement between the frame and the surgical table to which it is removably attached can eliminate the twisting and bending forces experienced by the frame and its spar members during use. This can prevent uncontrolled movement or even pulling apart of the patient support device during a surgical procedure, while allowing for easy storage of accessories with minimal steps. It can also prevent breaking and / or cracking of the frame spar. [Means for solving the problem]

[0012] At least one embodiment of the present invention includes an accessory or accessory system for use with a surgical table, as well as a method of using such an accessory or accessory system having one or more features recited in the accompanying claims, or one or more features or combinations thereof, which alone or in combination may comprise patentable subject matter.

[0013] An accessory for attachment to a surgical table capable of supporting a portion of a patient's body during surgery includes a linear frame of radiolucent members ("spars"), two such spaced apart spars generally parallel to one another and connected by a pivot member generally perpendicular to one or more of the spaced apart support members and / or spars. The spars are linear in shape. The support structure may include a base, a support column attached to the base, and an adjustment column extending upwardly away from the support column and / or retracting downwardly into the support column. In some embodiments, the lockable rotating head may have a top surface, a bottom surface, a distal horizontal surface, and a proximal horizontal surface. The lockable rotating head may be attached at its bottom surface to the top surface of the adjustment column. The rotating head may rotate about an axis running perpendicular to the floor and running through the centers of the adjustment column and support column and below the floor. The rotating head may have a recess formed in its distal horizontal surface, into which a distal portion of a multi-axis joint may be coupled. This recess in the rotating head may have a hole formed in its horizontal surface.

[0014] In one embodiment, the multiaxial joint may include a primary clamp having a circular notch formed at its proximal end. The primary clamp may also have a housing at its distal end, with a single horizontal notch bifurcating the housing. This bifurcation creates upper and lower clamp housings. This bifurcation may extend through the primary clamp housing and may also diverge partially around the circular notch formed at its proximal end. The distal clamp housing has upper and lower clamp housings and an upper (top) and bottom proximal surface. The lower clamp housing may have a horizontal channel or hole formed in its distal horizontal surface, which extends through a portion of its length. The upper clamp housing may have a hole or recess formed in its top surface, which is generally perpendicular to and extends into the horizontal hole or channel formed through a portion of the length of the lower clamp housing. An angled stack washer or stacked disc spring may be inserted into the vertical hole at the top surface of the clamp housing, and a cap is placed over the hole after the stack washer is inserted therein. The operation and structure of the angled stack washer system is well understood and will not be depicted here. When in place and capped, the angled stack washer acts to exert constant pressure on the upper and lower clamp housings to close the gap created by the bifurcation or notch between them, while simultaneously reducing the diameter of the clamp's rotating hub by closing the bifurcation or notch created through the circular notch in the main clamp.

[0015] A channel formed through a portion of the lower clamp housing is in some embodiments aligned with a hole formed through a recess formed in the proximal horizontal surface of the rotary head, the hole exiting the distal horizontal surface of the rotary head.

[0016] The proximal end of the rotatable cam may have a cam block formed or attached thereto. The distal end of the cam may have a handle attached thereto. The proximal end of the cam may be inserted through a horizontal hole formed through the proximal and distal horizontal surfaces of the rotatable head. The cam with the cam block may further be inserted into a horizontal channel formed through a portion of the length of the lower clamp housing. The cam block attached or formed in the proximal end of the cam may be aligned once it is placed within this channel formed in the lower clamp housing and may exit the horizontal channel of the lower clamp housing in alignment with a vertical hole formed through the upper clamp housing.

[0017] The distal end of the cam with the cam block may have a handle that, when rotated, can move the cam from a first position to a second position. The cam block on the proximal end of the cam may interact with the bottom end or bottom surface of a formed angled washer or disc spring stack placed in a horizontal hole formed through the upper clamp housing. When placed in the second position, the proximal end of the cam with the cam block interacts with the bottom of the angled washer or disc spring stack and pushes it upward. This interaction between the cam block and the angled stack washer exerts an upward force on the angled stack washer, relieving pressure exerted by the angled stack washer on the upper and lower clamp housings and on the branch formed in the circular notch of the primary clamp, thereby opening the horizontal notch formed through the clamp housing and the notch created through a portion of the surface of the circular notch of the primary clamp, thereby increasing the diameter of the circular notch of the primary clamp.

[0018] A suitable metal may be used to form the rotary hub. The rotary hub may be circular with a circular periphery, flat sides, one hole formed through its center, and four through holes formed around the center hole. Two round hemispherical segments made from a suitable material or metal may be placed around the periphery of the rotary hub. The hemispherical segments have an outer periphery with a curved surface and an inner periphery with a curved surface, both surfaces having a common radius. The outer surfaces of the hemispheres may mate with the outer surface / periphery of the rotary hub. The rotary hub with the two hemispheres mating with its outer surface may be placed within a circular cutout in the main clamp. The circular cutout in the main clamp may be formed to tightly fit the rotary hub attached to the hemispheres. The combination of the mated half hemispheres and the rotary hub may be contained within a circular notch in the rotary hub by placing a yoke pivot member through the centers of the two hemispheres and the central hole in the rotary hub, with each end of the yoke pivot member attached to a first clevis end of the yoke. The circular cover plates may be sized to fit the outer circumference of the rotary hub. The circular cover plates may have a hole formed in their centers sized to receive the yoke pivot member and four through holes that mate with four holes formed through the rotary hub. The circular cover plates may also have four holes formed around the central hole. The yoke pivot member may have a locking pin that fits into through holes formed at or near each end of the pivot member. The yoke pivot member may be circular and, in some embodiments, may be threaded at one or both ends. In other embodiments, the yoke pivot member may have holes formed near each of its ends. In other embodiments, the yoke pivot member may have a cap at one end and be threaded at the other end. The fixing bolts may be placed through four through holes formed in the first circular plate. These fixing bolts may be pushed through fixing holes in the rotatable hub, removed from the fixing holes, and fitted through four holes formed in an opposing second circular plate fitted to the opposite side of the rotatable hub. The fixing bolts may be capped on one end and secured to the cover plate by placing a lug on the exposed threaded end of the fixing bolt. The yoke may have first and second clevis ends with holes at each end.

[0019] The yoke pivot member may pass through a hole in one clevis end of the yoke, then through a hole formed in the center of a first circular cover plate, then through the center of a hole in the rotating hub, and then out through a rotating hole formed in the center of a second circular cover plate. The end of the yoke pivot bolt may be threaded and capped with a lug. The threaded end of the yoke pivot member may then be capped with a lug, creating a multi-axis joint from this hemispherical assembly of the rotating hub and main clamp.

[0020] The cam may be placed in a second position where the canted or spring-loaded washers can apply pressure to the upper and lower housings of the rotary hub, thereby closing the gap between the upper and lower housings and reducing the diameter of the circular cutout in the rotary hub. As this occurs, pressure is applied to the hemispheres that mesh with the inner circumference of the rotary hub, thus locking the hemispheres and the multi-axis coupling assembly from moving.

[0021] Conversely, when the cam is rotated to the first position, the cam block of the cam pushes against the ramp stacks or disc spring stacks, releasing pressure applied to the upper and lower housings of the clamp and the notches in the surface of the rotatable hub. Releasing pressure applied by the inner surface of the circular portion of the rotatable hub to the mating outer surfaces of the half hemispheres unlocks the multiaxial joint, thereby allowing movement of the multiaxial joint.

[0022] Some embodiments include a yoke connecting the polyaxle to a first end of the frame, and the yoke may have a first clevis end with a through hole corresponding to each of the two tangs, and a second clevis end with a through hole corresponding to each of the two tangs.

[0023] In one embodiment, the threaded ends of the yoke pivot member protruding from the circular plate of the multiaxial joint may be placed through holes in each tang of the first clevis end of the yoke, and in this embodiment, lugs may be placed on the threaded ends, thus attaching the first clevis end of the yoke to the multiaxial joint.

[0024] In other embodiments, the yoke pivot member may be fitted with a cotter or locking pin placed in a through hole formed in each end of the yoke rotation member to lock it in place.

[0025] The yoke may have an opposing second clevis end opposite the first clevis end of the yoke. The second clevis end of the yoke may be attached to the first end of the frame by at least one distal pivot member. In some embodiments, there may be two distal pivot members. One or more distal pivot members may be threaded at each end. In some embodiments, the distal pivot members are circular in cross section. The distal pivot members may pass through a through hole in one tang of the second clevis end of the yoke, then through holes formed in the distal region of each spar, then into the opposite through hole in the second clevis end of the yoke and be capped with a lug at the threaded end of the distal pivot member, thereby coupling one end of the yoke to the first end of the frame.

[0026] In one embodiment, the rotary head, multi-axis joint, and yoke, with their associated pivot members and rotary elements, comprise a gimbal that, in combination with a proximal pivot member that attaches the frame to the surgical table, allows the linear frame to move or articulate about six axes of rotation. Two or fewer axes of rotation may be rotationally locked, in one embodiment, by placing a cam on the multi-axis joint in a second position. The rotary lockable head may also be rotationally locked by a lever inserted into the rotary lockable head that impacts the head when placed in the second position to block any rotation. When in the first position, the lever allows the rotary lockable head to rotate as desired.

[0027] The accessory may further include a proximal coupler that may pivotally couple a second end of the linear frame to the surgical table such that the two spars extend away from the surgical table with a linear frame that may articulate relative to the surgical table in response to movement of a portion of the surgical table and / or in response to movement of the support or adjustment column. The spars may be configured such that the two spars are generally parallel to one another, with at least one support member attaching the spars to one another, such one or more support elements being generally perpendicular to the spars.

[0028] The spars may be spaced apart so that the patient's upper body can be supported by the attachment and at least a portion of the patient's legs can be supported by the operating table during a surgical procedure. The frame may have at least one pivot member connecting the spars at their second ends. The distal and proximal pivot members at the first and second ends of the frame are generally parallel to each other and generally perpendicular to the spars of the frame. A pivot member may be present at the first end of the frame, but a pivot member may also be present at the second end of the frame. In other embodiments, two pivot members may be present at the first end of the frame and at least one pivot member at the second end of the frame. The pivot member may also act as a support structure extending from the inner surface of at least one spar to the inner surface of the opposing spar.

[0029] In other embodiments, the first end of the frame is attached to the second clevis end of the yoke by two or more pivot members rather than a single pivot member. The pivotable connection between the operating table and the second end of the frame using a proximal pivot member allows the associated patient's spine to be more lordotic or kyphotic before, during, and after a surgical procedure by simply raising the operating table and / or raising or lowering an adjustment column on an accessory. One or more distal pivot members attaching the first end of the frame to the second clevis end of the yoke allow the first end of the frame to pivot up and down relative to the base of the accessory and the operating table base to which the frame is removably coupled. Each side of the frame can be moved up and down relative to the operating table base when the adjustment column is raised or lowered and / or when the operating table is raised or lowered. Additionally, the frame can move left and right in response to movement or articulation of the operating table. This is achieved by the rotary shaft of the rotary head and the multi-axis joint, which is then attached to a first clevis end of a yoke and a second clevis end of a yoke which is connected to the first end of the frame by a pivot member.

[0030] When the rotary cam is in the second position, it unlocks the multi-axis joint and allows movement of the yoke to which the multi-axis joint is attached and the frame to which the yoke is attached, thereby allowing the multi-axis joint to rotate in response to movement during articulation of the surgical table and movement when the adjustment column is moved.

[0031] Additionally, when the cam is in a second position, the multi-axis joint is locked in motion, preventing movement of the frame in at least two axes simultaneously. Articulation of the surgical table through its range of motion may be achieved, by way of example, using one or more electric linear actuators on the surgical table.

[0032] The patient support devices may have channels formed in their length designed to fit snugly over the spars. The patient support devices may be removably attached to the spars and may have latches in locked and unlocked positions. A portion of the patient's body may be positioned over the patient support device. When in the locked position, the patient support device cannot be moved along the spars. When in the unlocked position, the patient support devices may be moved along the spars, allowing them to be positioned under the patient's body as desired. The patient support devices may include devices for supporting the chest, arms, and buttocks, as well as other parts of the body.

[0033] The patient support device may be coupled to the spar and may include a head support, a chest support, a hip support, an arm base (arm support), and a leg support, among others. The attachment may be used without a panel or table section extending under the patient's abdomen, thereby allowing the patient's abdomen to hang down without any obstruction. The panel or section may be attached to the radiolucent spar and may support a mattress cushion pad.

[0034] The coupler between the second end of the frame and the distal end of the operating table may include at least one proximal pivot member extending generally horizontally from at least one spar. The coupler may further include at least one proximal clamp capable of receiving the proximal pivot member, which is connectable to the operating table and allows pivotal movement or rotation of the second end of the frame about the generally horizontal axis of the pivot member. The proximal clamp may also include a clamp body with a channel sized to receive an accessory rail of the operating table, a clamping screw capable of compressing the accessory rail, and a clamping knob for removably connecting the proximal clamp to the operating table. The clamp may include a spring-loaded toggle arm extending from the body of the clamp, while the clamp may have a curved surface or opening on which the proximal pivot member resides and which can be captured by the spring-loaded toggle arm. Additionally, the clamp may have a second clamping screw or system that compresses the rail-receiving channel over the operating table side rail.

[0035] The proximal pivot member may have a groove or helix formed around its periphery and the threaded end. The proximal pivot member may also have a circular capture plate attached to each of its ends. Each spar may have an end cap fitted to its proximal end. The spar proximal end cap may have a spring-loaded actuator positioned within a channel formed therethrough. When the spring-loaded actuator is in an intermediate position, it exerts pressure on the proximal pivot member, preventing movement of the proximal pivot member. When pressed or pushed, the actuator allows outward movement of the distal pivot member and the capture plate attached thereto, thereby allowing the distal pivot member to be removably attached to surgical tables of various widths.

[0036] The proximal pivot member may have a capture plate with a threaded hole, which may be attached to the threaded end of the proximal pivot member.

[0037] During articulation of the frame relative to the operating table, the proximal pivot member may rotate and slide on the curved surface of an opening formed in one end of the proximal clamp.

[0038] The proximal clamp may have a spring-loaded toggle arm movable between a first position that locks when in the intermediate position and a second position that, when moved to the second position, allows the proximal pivot member to be removed from the opening in the clamp.

[0039] Each spar may include a carbon fiber tube and a filler material within the tube. The filler material may include a polyurethane foam material. The tubes or spars may be generally quadrilateral in cross section. In some embodiments, the spars may be approximately 1.25 inches (3.175 cm) wide and approximately 1.5 inches (3.80 cm) high. In some embodiments, at least two spars may be generally parallel to one another and spaced 14 inches (35.6 cm) apart as measured between the insides of their facing surfaces, or approximately 17.5 inches (44.5 cm) apart as measured from the outer surface of one spar to the outer surface of the opposing generally parallel spar. In these embodiments, having a frame made up of spar members in this arrangement may allow any patient support accessory, which may alternatively be a Jackson, Allen Advance, or other specialized table, to be attached to the spar members of the frame as in the above embodiments.

[0040] Further to the present disclosure, an accessory that can be attached to a surgical table to support a patient during surgery may be removably attached to the surgical table to support the patient and may be stored when not in use. The storable accessory may include a generally linear frame having at least two radiolucent spars, the two radiolucent spars being linear in cross section, the spars being generally parallel to one another, and at least one support member connecting the spars. At least one pivot member extends outward from the mid-plane of one spar and connects it to the opposite spar. In some embodiments, the at least one pivot member acts as a structural member connecting the two spars. In other embodiments, there is at least one pivot member and one support member, extending outward from the mid-plane of one spar and connecting it to the opposite spar. The at least one pivot member or support member is generally perpendicular to the spars.

[0041] The accessory may further include an accessory base with a support column coupled to the base. The support column is generally perpendicular to the floor and the base. The support column may have an adjustment column nested within it and extending therefrom. The support column may further include an electric linear actuator that may move the adjustment column outward and upward from the support column or may pull the adjustment column downward into the support column.

[0042] In some embodiments, there may be only one support column extending from the base, driven up and down by a linear actuator nested within the column. The base may include a straight or U-shaped base frame and a pair of hooks. In other embodiments, the base may be quadrilateral-shaped or shaped like an "X" with a central area onto which the support column is affixed. The base may be weighted to enhance the anti-tilt characteristics of the accessory. In other embodiments, the base may include a base frame with a notch or notch formed in the top surface of the base to receive the second end of the frame when the accessory is not in the use position.

[0043] The frame may have one or more pivot members extending outward relative to the radiolucent spars at the first and second ends of the frame. The one or more pivot members at the second end of the frame may rest on hooks formed on or fitted to the top or side of the base. In other embodiments, at least one distal pivot member may rest in a base notch formed in a "V" shape in the top surface of the base when the frame is in the storage position. In other embodiments, the hooks may extend from one side of the base. In some embodiments, the hooks may extend from two sides of the side of the base. In other embodiments, the hooks may extend upward from the front top surface of the base. The hooks may be formed into or fitted to the surface of the base.

[0044] The surgical table may have a base with columns that use electric linear actuators to raise or lower and tilt the surgical table during or before surgery. The surgical table may have side rails running longitudinally along its length, on which patient support devices may be mounted.

[0045] The accessory may further include a pair of distal clamps coupleable to the side rails of the surgical table. The proximal pivot member of the accessory may be coupleable to the distal clamps when the frame is in the use position. The distal clamps may be removably attached to the side rails at a distal region of the surgical table.

[0046] The gimbal may include a rotary head attached at its underside to the upper region of the adjustment column, or in some embodiments, to the top surface of the adjustment column, and a multi-axis joint coupled to the rotary head's proximal horizontal surface, the proximal end of which is attached to a yoke with two clevis ends. The rotary head may be rotatable and lockable, with a rotation axis generally perpendicular to the floor and parallel to the adjustment column. The multi-axis joint may have a cam inserted therein, allowing rotation about at least three axes when the cam is in a first position, while simultaneously locking rotation about at least two of these axes when the cam is in a second position. The multi-axis joint may rotate about three rotation axes, including a first axis (the horizontal multi-axis joint axis) that is generally parallel to the floor and perpendicular to the frame, and can rotate up to 360° about this axis. The multi-axis joint may rotate about a second axis (the vertical joint axis) that is generally perpendicular to the floor and parallel to the adjustment column, and may rotate about this axis by up to approximately 25°. Finally, the multi-axis joint may rotate about a third axis that is generally parallel to the floor and parallel to the spar of the frame, and may rotate about this axis by up to 25°. These rotation axes are shown in Figure 1.

[0047] The yoke may have opposing first and second clevis ends. The yoke pivot member may rest on and protrude from opposing cover plates of the multiaxial joint. The first yoke clevis end may have a hole formed therein into which a yoke swivel member may be inserted and capped, thereby coupling the first clevis end of the yoke to the multiaxial joint.

[0048] In some embodiments, the spar at the first end of the frame may be attached to the first clevis end of the yoke by a distal pivot member, the pivot member being generally perpendicular to the spar. In other embodiments, the spar at the first end of the frame may be attached to the first clevis end of the yoke by two pivot members. The second clevis end of the yoke may be attached to the multi-axis joint via a yoke pivot member protruding from the multi-axis joint. The multi-axis joint may allow movement in three axes and may lock rotation about two of these axes when the rotary cam is in a second position. The rotary head to which the multi-axis joint is coupled may be fitted onto a mounting position attached at the top region of the adjustment column. The mounting position may be configured to allow the rotary head to be rotated up to approximately 45° in a plane generally parallel to the floor.

[0049] The second end of the frame may be removably attached to the distal end of the surgical table by a proximal pivot member. The gimbal may include a yoke with two clevis ends, the second clevis ends of which are coupled to one or more distal pivot members, a multi-axis joint movable in three axes of rotation and lockable for all movement about two of these axes of rotation, the multi-axis joint attached at its proximal end to the first clevis end of the yoke, and a lockable rotary head attached to a distal side of the multi-axis joint.

[0050] A distal pivot member, or in some embodiments, multiple distal pivot members, may be attached to one clevis end of the yoke and may also be attached to the first end of the frame.

[0051] The gimbal allows the first end of the frame to pivot about the generally parallel axes of the yoke support pivot member and the distal pivot member when the adjustment column is raised and lowered and / or the operating table is raised and lowered.

[0052] The multiaxial joint has a yoke pivot member protruding from a cover plate coupled to two outer horizontal surfaces of the multiaxial joint. The yoke pivot member may connect the multiaxial joint to a second clevis end of the yoke, while a distal pivot member may attach a first clevis end of the yoke to a first end of the frame.

[0053] The multiaxial coupling is capable of rotational movement about at least five axes, including at least the following axes: A rotation axis EE running through the rotary head, generally perpendicular to the floor and running through the general center of the adjustment column and support column nested therein. An axis of rotation CC that is generally parallel to the floor and runs generally through the center of the multiaxial joint. A rotation axis DD runs through the multi-axis joint that is generally perpendicular to the floor and generally parallel to the adjustment column. A rotation axis FF that is generally perpendicular to the adjustment column, generally parallel to the floor, runs generally along the longitudinal axis of the frame, and runs through a multi-axis joint that generally bifurcates the operating table. A rotation axis BB runs through the distal pivot bolt that attaches the first clevis end of the yoke to the first end of the frame. The frame rotates about the proximal pivot member, the axis of rotation AA being generally horizontal to the floor and the axis of rotation BB.

[0054] The multi-axis joint may be capable of locking at least two axes of rotation simultaneously. Attaching the second end of the frame to the distal end of the surgical table by a proximal pivot member may further enable the frame to pivot about the lateral and longitudinal axes of the spar extending from the support column. This pivoting about the axis of the proximal pivot member may occur due to actuation of a linear actuator in the surgical table that raises and lowers the surgical table, or due to raising and lowering of an adjustment column.

[0055] Linear actuators within the operating table can tilt the table relative to the floor and articulate the table surface at angles up to about 60° relative to a plane perpendicular to the floor. In particular, the multi-axis joints and yokes to which the frame is attached allow the frame to tilt about axes running parallel to the operating table surface and floor as the operating table articulates about these planes.

[0056] The gimbal allows the first end of the frame to move side to side in a plane parallel to the floor as the operating table is articulated through its range of motion. The gimbal also allows the attached frame to move side to side in a plane parallel to the floor when the operating table is tilted at an angle to the floor and when the head compartment is lowered and the foot compartment is elevated (the "Trendenburg" position) without compromising the rectangular cross-sectional shape of the frame and spars.

[0057] By raising or lowering the surgical table or the adjustment column, the proximal pivot member can pivot the second end of the frame relative to the surgical table, the floor, and the accessory base.

[0058] The rotary head may have one end attached to the top of the adjustment column and the other end attached to the multi-axis joint. The multi-axis joint may be attached to the yoke at its distal end or its second clevis end. The yoke may be attached at its proximal end or first clevis end to the distal pivot member, or in some embodiments, to the distal pivot bolt. The distal pivot bolt or distal pivot member is then coupled to the first end of the frame. The adjustment column may be extendable from the support column, within which the adjustment column is retracted or nested to increase the elevation of the first end of the frame relative to the base. The adjustment column to which the frame is coupled may be retractable within the support column, within which the adjustment column is retracted to reduce the elevation of the first end of the frame relative to the base. The adjustment column may have an electric linear actuator housed therein, which may be used to raise and lower the extension column or to extend it upward from the support column in which it is housed.

[0059] The accessory may further include a set of casters coupled to the base, with support columns extending upward and away from the base. While the casters may be spaced apart from the floor when the base is in its normal use position, the casters may engage the floor, allowing the base and associated frame to be moved for transport in one embodiment. In other embodiments, the casters may have spring actuators and locking pedals. When engaged, the casters lock into place. In other embodiments, when the locking pedal is engaged, the casters spring up and away from the attached base, causing the base to contact the floor, thereby stabilizing the accessory. A handle may be coupled to an upper region of the support columns. In other embodiments, the handle may be coupled to an upper region of the adjustment column. The handle may be grasped to push the wheeled base to a desired location, or alternatively, may be used to pull the accessory to a desired position. The handle may include a horizontal bar with a grip on the side opposite its attachment point to the accessory.

[0060] Also according to the present disclosure, the accessory may include a frame, a base supportable on the floor during surgery, and a support column extending upward from the base. The support column may have a housing, and one or more adjustment columns may be within and coupled to the housing. The adjustment column may also act as a second support column for the accessory. The support column may have a linear actuator coupled to the adjustment column, which, when actuable, may drive the adjustment column upwardly and away from the base, or alternatively, the linear actuator may pull the adjustment column downwardly into the support column relative to the base, thereby changing the effective height of the support column.

[0061] A panel may also be provided that may be coupled to a spar. An end of the panel may be supported on a support member, spar, or pivot member so that the panel spans a space defined between the frame members. At least one end of the panel may have a notch therein, and a portion of one of the frame members is exposed through the notch. A first side of the spark clamp may be coupled to the spar or to the portion of one of the frame members exposed in the notch. A second side of the spark clamp may have an attachment rail attached thereto. A second clamp may be coupled to the attachment rail. The second clamp may be removably coupled to an arm base or other accessory. A mattress or pad may be removably attached to the panel. The mattress may have a portion that overlies the notch and the first clamp when the mattress is attached to the panel.

[0062] Additional features, either alone or in combination with any other features, such as the features recited above and in the appended claims, may comprise patentable material and will become apparent to those skilled in the art after reviewing the following detailed description of exemplary embodiments illustrating different modes for carrying out the embodiments as presently contemplated.

[0063] The accessory includes a substantially linear radiolucent frame with two spaced apart spars having a linear cross section, spaced apart support elements, a column supported on the floor, an adjustment column housed within and extending from the support column, an electric linear actuator attached to the adjustment column, and a rotating head with a top surface, a bottom surface, and a proximal horizontal surface. The adjustment column and the rotating head are coupled at the top surface of the adjustment column and the bottom surface of the rotating head. The rotating head may rotate about one axis of rotation. The rotating head is attached to a swivel joint that is free to move about three axes of rotation. The swivel joint is then attached at its first end to a yoke, and the second end of the yoke is coupled to the first end of the frame via a distal pivot member. The distal pivot member can pivot the first end of the frame about one axis of rotation. The second end of the frame can be removably coupled to a distal end of a surgical table via a proximal pivot member, which can pivot the second end of the frame about another axis of rotation. The frame, including the rotating head, swivel joint, and proximal and distal pivot members, is free to move about at least six axes of rotation. These axes of rotation are shown in FIG. 1 and are designated Axis AA, Axis BB, Axis CC, Axis DD, Axis EE, and Axis FF, and illustrate one embodiment of a frame 122 of the present disclosure, as well as a surgical table 002 to which it is removably coupled. At least two axes of rotation of the frame can be simultaneously locked and unlocked for rotation, while Axis EE of the frame can be independently locked for rotation.

[0064] The frame is movable to a compact storage position with the second end of the frame supported on the base. The frame may have a leg, chest, or hip support ("patient support device") removably attached thereto. The patient support device can be moved up and down the spurs of the frame while in the unlocked position and can be held in place on the spurs when in the locked position. The frame is designed in such a way that the patient support device does not need to be removed when storing the attached frame. A set of lockable casters is provided on the base of the accessory to allow it to be wheeled from one location to another and locked in place once in the desired position.

[0065] Another embodiment relates to an accessory for attachment to a surgical table supporting at least a portion of a patient's body, the accessory including at least one support structure having an adjustable length, a frame extending from a proximal end to a distal end, the distal end of the frame configured to be rotatably coupled to the surgical table, and a multi-axis joint mounted on the at least one support structure rotatably coupled to the proximal end of the frame, the multi-axis joint having at least a first rotational degree of freedom about a tilt axis of the frame and a second rotational degree of freedom about an axis orthogonal to the tilt axis of the frame.

[0066] In another embodiment of the accessory, the frame includes two spar members, each extending from a proximal end to a distal end of the frame, with each spar member rotatably coupled at its distal end to the surgical table.

[0067] In another embodiment, the attachment includes a yoke configured to couple the multi-axis joint to the spar member such that the multi-axis joint can simultaneously rotate the yoke about the frame tilt axis and an axis orthogonal to the frame tilt axis.

[0068] Another embodiment is directed to an accessory for attachment to a surgical table supporting at least a portion of a patient's body, the accessory including: at least one support structure having an adjustable height; a frame extending from a proximal end to a distal end, the distal end of the frame configured to be rotatably coupled to the surgical table; a multi-axis joint mounted on the at least one support structure, the multi-axis joint having at least three rotational degrees of freedom; and a yoke having a proximal end coupled to the distal end of the multi-axis joint and a distal end rotatably coupled to the proximal end of the frame, wherein coupling of the distal end of the multi-axis joint to the proximal end of the yoke can rotate the yoke about at least three rotational degrees of freedom, thereby rotating the frame about at least three rotational degrees of freedom.

[0069] In another embodiment, the accessory includes a coupler that pivotally and removably couples the distal end of the frame to the surgical table such that the at least two spar members can move in response to movement of the surgical table and / or movement of the at least one support structure.

[0070] In another embodiment, movement of the multi-axis joint about at least two of the at least three rotational degrees of freedom can be locked and unlocked simultaneously.

[0071] Another embodiment is directed to an accessory for attachment to a surgical table supporting at least a portion of a patient's body, the accessory including: at least one support structure extending from a proximal end to a distal end, the proximal end of the at least one support structure movable along a longitudinal axis of the support structure to adjust a length of the at least one support structure; a frame including at least two spar members each extending from a proximal end to a distal end, the distal end of each of the spar members being rotatably coupled to the surgical table; a multi-axis joint mounted to the proximal end of the support structure; and a yoke rotatably coupled to the proximal end of one of the at least two spar members and to the proximal end of another of the at least two spar members such that the yoke is rotatable about an axis substantially perpendicular to the longitudinal axes of each of the spar members, the multi-axis joint coupled to the yoke and configured to enable the yoke to rotate about an axis perpendicular to the tilt axis of the frame simultaneously with rotation of the frame about the tilt axis.

[0072] In another embodiment, the accessory further comprises a platform rigidly coupled to the distal end of the at least one support structure.

[0073] In another embodiment, the at least one support structure comprises a retractable beam.

[0074] In another embodiment, the frame can move about six axes of rotation.

[0075] In another embodiment, the accessory further includes a rotatable locking head that couples the polyaxial joint to the support structure, the rotatable locking head being rotatable about a longitudinal axis of the support structure.

[0076] In another embodiment, the rotatable locking head includes a lever movable between a first position and a second position, wherein when the lever is in the first position, the rotatable locking head is rotatable and when the lever is in the second position, the rotatable locking head is locked against rotation.

[0077] In another embodiment, the surgical table allows the frame to move or articulate about six axes of rotation.

[0078] In another embodiment, the frame is a rectilinear frame that includes a radiolucent member.

[0079] In another embodiment, the accessory further includes a lockable rotary head attached to the top surface of the support structure, the rotary head configured to rotate about an axis perpendicular to the floor and running downward to the center of the adjustment column and support column and the floor, and the distal portion of the multi-axis joint coupled thereto.

[0080] In another embodiment, the accessory further includes a lockable rotary head attached to the top surface of the support structure, the rotary head configured to rotate about an axis perpendicular to the floor and running downward to the center of the adjustment column and support column and the floor, and the distal portion of the multi-axis joint coupled thereto.

[0081] In another embodiment, the accessory further includes a lockable rotary head attached to the top surface of the support structure, the rotary head configured to rotate about an axis perpendicular to the floor and running downward to the center of the adjustment column and support column and the floor, and the distal portion of the multi-axis joint coupled thereto.

[0082] In another embodiment, a multi-axis joint includes a primary clamp having a circular notch formed therein, a rotatable hub having a through hole formed therein, a yoke pivot member configured to rotatably fit into the through hole, and a hemisphere disposed around the periphery of the rotatable hub and configured to be positioned within the circular notch, wherein the yoke is rotatably coupled to the yoke pivot member such that the yoke can rotate about the yoke pivot member.

[0083] In another embodiment, a multi-axis joint includes a primary clamp having a circular notch formed therein, a rotatable hub having a through hole formed therein, a yoke pivot member configured to rotatably fit into the through hole, and a hemisphere disposed around the periphery of the rotatable hub and configured to be positioned within the circular notch, wherein the yoke is rotatably coupled to the yoke pivot member such that the yoke can rotate about the yoke pivot member.

[0084] In another embodiment, a multi-axis joint includes a primary clamp having a circular notch formed therein, a rotatable hub having a through hole formed therein, a yoke pivot member configured to rotatably fit into the through hole, and a hemisphere disposed around the periphery of the rotatable hub and configured to be positioned within the circular notch, wherein the yoke is rotatably coupled to the yoke pivot member such that the yoke can rotate about the yoke pivot member.

[0085] Another embodiment is directed to an accessory for attachment to a surgical table supporting at least a portion of a patient's body, the accessory including a surgical table having a linear frame capable of moving or articulating about six axes of rotation; at least one support structure having an adjustable length; a frame extending from a proximal end to a distal end, the distal end of the frame configured to rotatably couple to the surgical table; and at least two or more joints mounted on the at least one support structure rotatably coupled to the proximal end of the frame, the at least two or more joints having at least a first rotational degree of freedom about a tilt axis of the frame and a second rotational degree of freedom about an axis orthogonal to the tilt axis of the frame.

[0086] Another embodiment is directed to a clamp configured to attach to a surgical accessory rail having an outer side and an inner side, the clamp including: a clamp body having a table rail receiving channel formed therein configured to receive the surgical accessory rail and first and second holes formed in the clamp body; first and second mating screws extending through the first and second holes, respectively; a first knob fitted over the first mating screw, such that upon rotation of the first knob, an end of the first mating screw strikes the outer side of the surgical accessory rail, thereby securing the clamp to the outer side of the surgical accessory rail; a rocker arm having a tip extending from the rocker arm; and a second knob fitted over the second mating screw, such that upon rotation of the second knob, an end of the second mating screw strikes the rocker arm, causing the rocker arm to tilt, such that a surface of the tip strikes the inner side of the surgical accessory rail, thereby securing the clamp to the inner side of the surgical accessory rail.

[0087] In another embodiment, the yoke may have first and second clevis ends, the first end of the frame may be attached to the first clevis end, and the second clevis end of the yoke may be attached to the connector.

[0088] The connector may be attached to a series of joints by a first end of the clevis yoke and then connected to a pivot joint at a first end of the frame. In this embodiment, the connector may be attached to an adjustment column. The connector may have a distal section and a proximal section, each section generally perpendicular to one another.

[0089] The proximal connector section may be rotatable and may be lockable against rotation. The frame may be pivotable and may have at least two pivot joints at its distal end for pivoting relative to the adjustment columns, allowing the frame to be stored on the base without adjusting the spars outward or inward relative to the connectors.

[0090] In one embodiment, the gimbal may include a connector attached at its distal end to an upper region of the adjustment column, or in some embodiments, at the top of the adjustment column, the connector attached at its proximal end to a yoke with two clevis ends. The connector may include a distal connector section generally parallel to the adjustment column and a proximal connector section generally perpendicular to the adjustment column.

[0091] In this embodiment, the proximal connector section may be rotatable and lockable and is generally parallel to the floor. The distal connector section may be rotatable and lockable and is generally perpendicular to the floor. The connector may be circular or oval in cross section and may be constructed from two or more sections of tubing attached or mated together.

[0092] Both connector sections may be formed from hollow tubes. The yoke may have opposing first and second clevis ends. The proximal connector section may have a proximal cap fitted onto a front surface of its proximal end, the proximal cap having a slot at its distal end and a yoke support pivot member positioned within the slot. The slot may be generally parallel to the floor. The yoke pivot member may have a through-hole formed midway along its length. The proximal connector's proximal cap may have aligned holes formed in its top and bottom surfaces and extending therethrough. The vertical pivot member may include a bolt with a capped end and a lug at its threaded end. The vertical pivot member may be positioned through a hole in the top central proximal surface of the proximal cap, pass through a through-hole positioned at the midpoint of the yoke pivot member, then pass through a hole formed in the bottom surface of the proximal cap and be capped with a lug at its threaded end.

[0093] In one embodiment, the spar may be attached to a first clevis end by a pivot member at a first end of the frame with a distal pivot member. The pivot member may be generally perpendicular to the spar. In other embodiments, the spar may be attached to a yoke pivot member at a first end of the frame with two pivot members, and the second clevis end may be attached to a yoke support pivot member. The first clevis end of the yoke may be attached to a distal pivot member, which is then attached to the first end of the frame.

[0094] The proximal connector section may be rotatable up to 90 degrees and may be lockable. The distal connector section may fit within a hole formed in the top surface of the adjustment column. There may be a flange attached or formed around the periphery of a lower region of the distal connector section that fits and is attached to a collar centered or located near the top of the hole in the upper surface of the adjustment column. This flange and collar combination allows the distal connector section to rotate within the hole and may be lockable against rotation.

[0095] The second end of the frame may be removably attached to the distal end of the surgical table by a proximal pivot member.

[0096] In some embodiments, the gimbal includes a yoke with two clevis ends, a rotating proximal connector section, a rotating distal connector section, a vertical pivot member coupled to the proximal connector section, a yoke pivot member coupled to the vertical pivot member and coupled to a second clevis end of the yoke, and a second clevis end of the yoke coupled to the distal pivot member.

[0097] The distal pivot member in this embodiment may be attached to a first end of a frame that can pivot about the generally parallel axes of the yoke support pivot member and the distal pivot member when the adjustment column is raised and lowered and / or the operating table is raised and lowered.

[0098] A vertical pivot member may attach the yoke pivot member to the proximal connector section, allowing the frame to move side to side in a plane generally horizontal to the floor.

[0099] The proximal connector section is generally perpendicular to the floor and can be attached to a distal connector section that is generally perpendicular to the proximal connector section.

[0100] The proximal connector section is rotatable about an axis that is generally horizontal to the floor and perpendicular to the distal connector section.

[0101] The distal connector section can fit into a hole formed in the top surface of the adjustment column and can rotate about an axis that runs through the center of the adjustment column and is generally perpendicular to the floor. Rotation of the distal connector section allows the frame to move side to side in a plane generally parallel to the floor.

[0102] In this embodiment, the gimbal is capable of rotational movement about at least five axes. Attaching the second end of the frame to the distal end of the operating table by a proximal pivot member may further enable the frame to pivot about the lateral and longitudinal axes of the spar extending from the support column. This pivoting about the axis of the proximal pivot member may occur due to actuation of a linear actuator in the operating table to raise or lower the axis, or actuation of a linear actuator in the support column to raise and lower the adjustment column.

[0103] In this embodiment, the gimbal allows the first end of the frame to move side to side in a plane parallel to the floor as the operating table articulates through its range of motion. In particular, the vertical pivot member allows the yoke to which it is indirectly attached, and the frame to which the yoke is further attached, to move side to side in a plane parallel to the floor when the operating table is tilted at an angle to the floor and when the head compartment is lowered and the foot compartment is elevated (the "Trendenburg" position), without compromising the rectangular cross-sectional shape of the frame and spars.

[0104] In one embodiment, the adjustment column is attached at its distal end to a connector. The proximal end of the connector is attached to a yoke at the distal end of the yoke. The yoke is attached at its proximal end to a distal pivot member, which is coupled to the first end of the frame. The adjustment column may be extendable from the support column, and the adjustment column may be housed or nested inside the support column to increase the elevation of the first end of the frame relative to the base. The adjustment column to which the frame is coupled may be retractable inside the support column, and the adjustment column may be housed in the support column to reduce the elevation of the first end of the frame relative to the base. The adjustment column may have an electric linear actuator housed inside it, which may be used to raise and lower the extension column.

[0105] In some embodiments, a gimbal may also be attached to a first end of the frame, and a proximal pivot member may be attached to a second end of the frame. The proximal pivot member may be removably coupled to a distal end of the surgical table. The gimbal and proximal pivot member may be configured to allow the accessory to move about up to six axes of rotation due to articulation of the adjustment column and / or the surgical table.

[0106] In some embodiments, the gimbal may include a connector with a rotating distal connector section attached to an upper region of the adjustment column and a rotating proximal connector section attached to a clevis end at a first end of a yoke having two opposing clevis ends.

[0107] Additionally, the gimbal, in some embodiments, may include a connector formed from a hollow tube. The connector may be formed or made from a metal or a rigid polymer or a combination thereof or other suitable material. The connector may also be integrally formed or molded, or may include two or more hollow tubes or hollow half-tubes mated together. The connector may have a distal section generally parallel to the extension column and generally perpendicular to the floor, and a proximal section generally perpendicular to the adjustment column and generally parallel to the floor, with the two connector sections forming an "L" shaped connector.

[0108] The proximal connector section, including a portion of the gimbal, may be generally parallel to the floor while being generally perpendicular to the support column, adjustment column, and distal connector section. The proximal connector section may be rotatable relative to the distal connector section. The proximal connector section may be locked in place to stop any further rotation relative to the accessory by use of a brake attached to the distal end of a handle. This brake handle may fit into a hole in the distal connector section, and its distal end may impinge on a gear-like feature formed in the distal region of the proximal connector section. The proximal connector section may have a proximal cap attached to its end or formed on its proximal end. In some embodiments, the proximal cap may be hemispherical in shape, while the distal end of the proximal connector section may be a hollow tube so that the proximal cap may be sized to fit snugly over and attached to the proximal end of the proximal connector section. The front surface of the proximal cap may have a generally horizontal slot formed thereon, the slot being generally parallel to the floor and the accessory base while being generally perpendicular to the adjustment column. A coaxial hole may be formed through the center of the top surface and the center of the bottom surface of the connector cap.

[0109] In some embodiments, the yoke pivot member may include a bolt threaded at both ends, which may have a through hole formed midway along its length. There may also be a vertical pivot member including a cap on one end and a threaded bolt on the other end, as well as a lug for capping the threaded end. The yoke pivot support member may be secured onto the connector cap by placing the vertical pivot member through a coaxial hole in the top surface of the connector cap, through a hole formed midway along the length of the yoke pivot member, and through a coaxial hole formed in the bottom surface of the connector cap. The vertical pivot member can then be secured in place by attaching and fastening the lug to its threaded end. The vertical pivot member allows rotational movement of the yoke and attached frame about the member in a plane generally horizontal to the floor and attached base.

[0110] In other embodiments, the coaxial holes are formed in the proximal top and bottom surfaces of the proximal connector section, and the proximal connector section has a slot formed in its proximal front surface, the slot being generally parallel to the floor and the accessory base.

[0111] In one embodiment, the yoke may be formed from metal or carbon fiber or other suitable material. The yoke may include two opposing clevis ends, including a first clevis end and a second clevis end. The forked portions of the second clevis end may be spaced apart to fit or closely nest around the outer surface of the connector cap or the distal region of the proximal connector section. The second clevis end of the yoke may have holes formed therein sized to receive each end of the yoke pivot member. The yoke pivot member, in some embodiments, may include a bolt with a threaded end. The yoke pivot member may be placed through the hole in the second clevis end, while a threaded nut may be engaged onto the threaded end of the yoke pivot member to couple the threaded end of the yoke pivot member to the second clevis end. The first clevis end may have a hole formed in its end region. The forked portions of the second clevis end may be spaced apart so that its outer surface fits closely against the inner surface of the distal region of the spar. The first end of the frame may include distal regions of the two spars and a distal pivot support member connecting the spars. The distal regions of the spars may have through-holes formed therethrough. A proximal coupler with a straight cross-section may have channels formed therein to receive the spars, so that the coupler fits snugly over the spars. The proximal coupler may have coaxial through-holes formed in its side and mid-surface. The distal pivot member may be generally perpendicular to the spars and have a threaded end. The threaded end of the distal support pivot member may pass through a hole in the proximal clevis end of the yoke, then through a corresponding hole located in the distal coupler, and fit through a hole formed in the distal region of the side of the spar. Lug nuts may be applied to each threaded end of the distal pivot member, securing the proximal clevis end of the yoke, the distal pivot member, and the two spars together to form one gimbal joint.

[0112] A yoke formed from metal, a rigid plastic polymer, or carbon fiber, or a combination of two or more such materials, may include two opposing clevis ends, one a first clevis end and the other a proximal end. In one embodiment, the distal clevis end may be sized to fit over an outer surface of a proximal cap of the proximal connector section and may align with a slot formed in the proximal cap that is generally level with the floor and accessory base. In other embodiments, the second clevis end of the yoke may be sized to fit over an outer surface of a distal region of the proximal connector section and may align with a portion of a slot formed in a front surface of the proximal connector section that is generally level with the floor and accessory base.

[0113] The first end of the frame may include a distal pivot member spanning the two spars and coupled to the second clevis end of the yoke and the two spars. The yoke has a first clevis end that can be attached to the yoke support pivot member. The yoke support pivot member can then be attached to the vertical pivot member. The vertical pivot member can be connected to the proximal connector section. The proximal connector section can be attached to the distal connector section via a through-hole sized to receive the proximal section. A flange on the distal end of the proximal connector section can be used, with the distal end of the flange fitting centrally and secured to its distal end with a bolt, securing it to the distal connector section but remaining free to rotate. A brake handle can fit into a hole in the back upper surface of the distal connector section. The distal end of the brake handle may mate with a gear-like feature formed in the outer periphery of the distal region of the distal connector section. When engaged within the gear-like notch, the brake handle can lock the rotation of the proximal connector section. The proximal connector section is generally parallel to the floor, while the distal connector section is generally perpendicular to the floor.

[0114] The detent handle may fit into a hole in the rear face of the adjustment column, and a distal end of the handle may mate with a detent feature on the distal connector section to lock its rotation. When the handle is disengaged, the distal end no longer mates with the detent feature on the distal connector section, allowing the distal connector section to rotate. [Brief explanation of the drawings]

[0115] [Figure 1] 1 provides a perspective view of one embodiment of the present invention, including certain details of the invention and the axis of rotation about which the frame may move. [Figure 2] 1 provides a perspective view of a distal portion of another embodiment of the present invention. [Figure 3A] 1 provides an exploded view of some aspects of at least some embodiments of the present invention, including a main clamp that includes a portion of a rotary head and a portion of a polyaxial joint. [Figure 3B] 1 provides perspective views of several aspects of the frame, including an exploded view of the rotating head, the frame, a patient support device attached to the spar of the frame, and several elements of the surgical table. [Figure 4] 1 provides an exploded view of a multiaxial coupling. [Figure 4A] 1 provides an exploded view of some elements of the distal end of the frame. [Figure 4B] 1 illustrates several aspects of the distal portion of the frame. [Figure 4C] 1 provides a perspective exploded view of some elements of the frame. [Figure 5] 1 provides a perspective view and some details of the proximal end of at least one embodiment of the present invention. [Figure 6] 1 illustrates several aspects of at least one embodiment of the present invention, including a proximal pivot member and a proximal clamp. [Figure 7] 1 illustrates a side view of a portion of at least one embodiment of the present invention, including a proximal clamp. [Figure 8] 1 provides a top cross-sectional view of several aspects of at least one embodiment of the present invention, including a proximal clamp. [Figure 9] 1A-1D provide top cross-sectional views of several embodiments of a proximal clamp. [Figure 10] 1A-1D provide cross-sectional views of several embodiments of accessory patient support devices. [Figure 11] 1 provides a perspective exploded view of a proximal portion of at least one embodiment of the present invention. [Figure 12] 1 provides a cross-sectional view of a proximal portion of at least one embodiment of the present invention. [Figure 13] 1 provides a cutaway perspective view of some components of the proximal pivot member; [Figure 14] 1 provides a cross-sectional view looking towards the distal end and base of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0116] FIG. 1 is a perspective view of one embodiment of the present invention, including six axes of rotation about which the frame can move. As shown in FIG. 1 , the accessory includes a wheeled storage base 3, a telescoping support structure 110 extending away from the base and coupled to a first end of a multi-axis joint 108, which in turn is coupled at its second end to a frame 122 having a first end and a second end removably attached to a surgical table 102. The frame 122 has a spar 104 coupled by a distal pivot member 134 and a proximal pivot member 118. The proximal pivot member 118 is removably coupled to the distal end of the surgical table 102. The distal pivot member 134 connects a yoke 132 to the first end of the frame 122. The multi-axis joint 108 can rotate about three axes C, D, and G (which are parallel to the spar). The rotary head 109 is rotatable about an axis E that is generally perpendicular to the floor and parallel to the longitudinal axis of the support structure 110. The yoke 132 includes two opposing clevis ends coupled to the multi-axis joint 108 and two distal ends rotatably connected to pivot members 134, thereby coupling the multi-axis joint 108 to a first end of the frame 122. The axes of rotation about which the frame 122 may articulate are shown with reference to FIG. 1 and include the following six axes of rotation: An axis AA about which the frame 122 rotates on the proximal pivot member 118, the axis being generally horizontal to the floor and the axis of rotation BB; an axis BB about which the frame rotates at the distal pivot member 134, which is generally parallel to the floor and generally parallel to the axis of rotation AA; a shaft CC branching off the multi-shaft joint 108; a shaft DD branching multi-shaft coupling 108; an axis EE bifurcating the rotary head 109 and the support structure 110 and generally perpendicular to the axes of rotation AA and BB; Axis FF branches off the multi-axis joint 108 and is generally perpendicular to the floor, runs generally along the midpoint of the operating table, and is generally perpendicular to other axes or rotations. may include:

[0117] FIG. 2 illustrates some aspects of one embodiment of the accessory, including a floor-mounted base 220 with two generally parallel spars 204, casters 216, and caster locks 223. A trough 224 is formed in the top surface of the floor-support base 220, as shown in cross-section AA. A support column 210 fits into the top surface of the floor-mounted base 220. An extendable vertical support is attached to the base 220. The extendable vertical support includes a support column 210 and at least one adjustment column 227 nested within the support column 210, which is used to extend the height of the extendable vertical support. Two, three, or more adjustment columns can be used. A linear actuator (not shown) can fit inside the support column 210 and attached (not shown) to the adjustment column 227, allowing the adjustment column to be extended upward and away from the base 220, or lowered or retracted into the support column 210. The mounting plate 262 is mounted to an internal mounting collar (not shown) that fits behind the top surface (not shown) of the adjustment column 227. The locking handle 229 fits within the distal horizontal surface of the rotatable lockable head 226. The polyaxial joint 208 can fit within and be coupled to a recess formed in the proximal horizontal surface of the lockable head 226. The yoke 232 has a second clevis end 232B with a through hole 232C formed therethrough, and a first clevis end 232A with a through hole 233. The through hole 233 is sized to receive the threaded bolt 228A. The distal mounting cap 206 can have a through hole 206A through its side and mid surface. In some embodiments, the distal mounting cap 206 can have a spur receiving channel 206B formed therethrough that is sized to receive the spur 204. The distal region of spar 204 may fit into receiving channel 206B. Spar 204 may have a through hole 204A formed through the side of its distal region. Distal mounting cap 206 may be fitted or slid onto the distal region of spar 204 such that hole 206A and hole 204A are aligned. First clevis end 232A of yoke 232 may fit through through hole 206A in distal mounting cap 206 and hole 204A in spar 204.The yoke collar 228 may then slide over the portion of the first clevis end 232A of the yoke 232 that protrudes from the side of the distal mounting cap 206. The yoke pin 228A may be threaded at one end and may be slid into a through hole 233 formed through the first clevis end 232A of the yoke 232. A lug 228B may then be attached to the threaded end of the yoke pin 228A, thus securing the first clevis end 232A of the yoke 232 to the spar 204.

[0118] FIG. 3A illustrates certain aspects of one embodiment of the present disclosure, namely, further details of the distal end of the rotating head and frame 322 (see FIG. 3B). The mounting plate 342 has a through hole 342B formed through its top surface and a threaded hole 342Q formed therein. The top surface of the adjustment column 327 has a threaded hole 327A formed therein. A threaded bolt 359 can pass through the through hole 342B in the top surface of the mounting plate 342 and thread into the threaded hole 327A in the top surface of the adjustment column 327 to secure the mounting plate 342 to the adjustment column 327. In this embodiment, the mounting plate 342 can have a locking ring 342L that mates with the bottom distal surface 301C of the top head plate 301. The puck 337 has a through hole 342T formed around its through hole 342R formed through its center. The pack 337 can be secured to the mounting plate 342 by threaded bolts 337B passing through holes 342T and into threaded holes 342Q in the mounting plate 342. The bearing aligner 336 has a through hole formed through its top plate, while the bottom of the bearing alignment post 336C has a threaded hole 336T formed in the central bottom surface of its end, as shown in bottom view AA. The coupling ring 349 has a central through hole 349P formed in its center and a through hole 349A formed around the central through hole 349P. The top plate 335 has through holes 335R formed around its periphery and a hole 335C formed through its center, as shown in top view BB.

[0119] Ring bearing 330 can be sandwiched between coupling ring 349 and top plate 335. Puck 337 can be coupled to mounting plate 342 by bolt 337B passing through through hole 342T and threading into threaded hole 342Q. Bolt 336A can be placed through through hole 336B in bearing aligner 336, through through hole 335R in top plate 335, and through through hole 349A in puck 349. Bearing alignment post 336C in bearing aligner 336 can pass through central through hole 335C in top plate 335, then through through hole 349P in puck 349, and through central through hole 342R in puck 337. A bottom plate 369 with a through hole 369B formed through its center can be placed around the portion of bearing alignment post 336C that protrudes from hole 342K in the bottom surface of mounting plate 342. A hole 369B formed in the center of the bottom plate 369 is smaller than the cap of the threaded bolt 369A. The threaded bolt 369 can then fit into a threaded hole (not shown) formed in the bottom surface of the bearing alignment post 336C.

[0120] A cover 358 with a circular portion 358A can fit over the top head plate 301. A flexible cover 321T with a circular notch 325 can be placed over the main clamp 321 when the main clamp 321 is assembled. An actuation handle 329 can be coupled to the distal end of the cam 311, while a cam block 313 can be coupled to the proximal end of the cam 311.

[0121] The yoke 332 is coupled at its upper end to the polyaxial joint 308 and at its lower end to a distal pivot joint (not shown). The distal pivot joint (not shown) is attached to a proximal spar coupler 399. The proximal spar coupler 399 has a channel (not shown) sized to receive the spar 304, and the spar may be fitted into the coupler using the channel. The patient support device 370 may be fitted over the spar 304.

[0122] 3B illustrates another aspect of an embodiment of the present invention, including an exploded view of the rotating head 326 and polyaxial joint 308, and a perspective view of the spar 304 with a patient support device 357 attached to the spar. The frame 322 can be attached to the surgical table 302 via a proximal pivot member 391, which is removably coupled to a proximal clamp, which is in turn removably coupled to the attachment rail 342 or the surgical table 302. The spar 304 is attached to a proximal spar cap 391 and a distal spar cap 399, with the proximal pivot joint 351 attached to the proximal spar cap 391 and the distal pivot member 334 attached to the distal spar cap 399. The yoke 332 is coupled at its lower end to the distal pivot member 334 and at its upper end to the polyaxial joint 308.

[0123] An exploded view of some components of the multi-axis joint 308 is also shown, including the main clamp 321 with the circular notch 325 and flexible cover 321T. The cam 311 has a handle 329 and a cam block 311 to which it can be coupled. When the cam is in the second position, the multi-axis joint is locked, preventing frame movement in at least two axes simultaneously. Fewer than two rotational axes can be locked from rotation by placing the multi-axis joint's cam in the second position. A cover 358 with a circular portion 358A may be placed on the top head plate 301. Components of the rotating head 326 include the top plate 301, bearing aligner 336, top plate 335, ring bearing 330, coupling ring 349, puck 337, and mounting plate 342. A base 323 with a storage trough 324 formed on its proximal front face has a caster 316 with a locking portion 323. Storage trough 324 can be configured to support the proximal end of frame 322 when the frame is moved to a vertical storage position, thereby placing accessories in a compact storage position and supporting the frame on base 320. Support column 310 is formed in the top surface of base 320. Adjustment columns 327 and 327A extend upwardly and away from support column 310, thereby forming a vertical support having an adjustable height.

[0124] FIG. 4 shows a perspective view of one embodiment of the present invention, namely, multiaxial joint 408. Multiaxial joint subassembly 441 has a yoke pivot member 453 with a horizontal notch / slot 453A formed around its periphery and running its length, sized to accommodate the entire length of a capture element 456 and half the width of the capture element. Yoke pivot member 453 has through-holes 453B at each of its ends. Rotating hub 454 has through-hole 454B formed through its center and sized to receive yoke pivot member 453. Through-hole 454B has a receiving notch 454C formed in its inner periphery and running along the inner surface of through-hole 454B. Rotating hub 454 has a woodruff key notch 454A designed to receive woodruff key 452. The capture element 456 is sized to fit within the entire length L of the notch 454C, with half of its width W captured therein and half of its width W protruding the length of the notch. A hemisphere 445 is placed around the rotatable hub 454. The hemisphere 445 may be made from cast iron, aluminum, or any other similar metal. The yoke pivot member 453 is placed through a through hole 454B in the rotatable hub 454, with the capture element 456 placed in the slot 453A and the woodruff key 452 placed in the woodruff key notch 454A. The hemisphere 445 is then nested around the curved outer surface of the rotatable hub 454 and placed inside the circular notch 423 of the main clamp 421. A cover plate 455 has a through hole 455A formed therethrough. The cover plate 455 is placed on the outer surface of the rotatable hub 454. Hole 455A aligns with through-hole 454C in rotatable hub 454. Bolt 455B, capped at one end and threaded at the other, is placed in through-hole 455A in one cover plate 455, then passes through through-hole 454C in rotatable hub 454, and through through-hole 455A in the opposite cover plate, where bolt 455B is secured by lug 455C. Yoke pivot member 453 may pass through through-hole 455D in the first cover plate 455 and then slide through through-hole 454B formed through the surface of rotatable element 454 so that horizontal slot 453A in pivot member 453 captures the width of capture element 456. Yoke pivot member 453 may be pushed through the side of second capture plate 455.The ends of the yoke pivot member 453 protrude from the outer surfaces of the first and second supplemental plates 455. A collar 448 has a through hole 448A formed therearound and is placed around each protruding end of the yoke pivot member 453. A threaded bolt 449 capped at one end may be placed through the through hole 448 and secured in place by a lug 449B. Placing the collar 448 secured by the threaded bolt 449 around the yoke pivot member 453 secures the hemisphere 445 in the circular notch 423 of the main clamp 421.

[0125] FIG. 4A illustrates another embodiment of the present disclosure, including a yoke 432 having a first clevis end 432A and a second clevis end 432B. Through-holes 432D and 432C are formed in the tangs of the first clevis end 432A and the second clevis end 432B, respectively. A primary clamp 421 has a circular notch 423 formed therein, and a slot 422A is formed in a portion of its distal circumference. The slot 422A separates an upper clamp housing 425 from a lower clamp housing 425A. Section AA shows a side view of the distal side of the primary clamp 421, with the slot 422A separating the upper clamp housing 425 from the lower clamp housing 425B. A channel 425C is formed from the distal face of the lower clamp housing 425A and runs most of the length of the lower clamp housing. A through-hole 417 is formed in the top surface of the upper clamp housing 425, extends through the upper clamp housing, and penetrates the top surface of the lower clamp housing 425A, where it intersects with the channel 425C. A tapered or spring stack washer 412 can be inserted into the through-hole 417 so that a portion of the washer protrudes into the channel 425C and is held in place by a cap 412A. The hemispheres 445 are sized so that their inner peripheries fit snugly around the outer periphery of the rotatable hub 454. The outer periphery of the hemispheres 445 is sized to fit snugly around the inner surface of the circular cutout 423 of the primary clamp 421. The rotatable hub 454, with the hemispheres 445 fitted around its outer periphery, may be placed in the circular cutout 423 of the primary clamp 421. The rotatable hub 454 has a hole formed in its center. The yoke pivot member 453 can slide through a through hole 432C in the second clevis end 432B of the yoke 432. The yoke pivot member 453 can then slide through a hole 454B in the center of the rotatable hub 454 when seated inside the circular cutout 423 of the main clamp 421. The other end of the yoke pivot member 453 can then slide through a through hole 432C formed in a tang of the second clevis end 432B of the yoke 432. A cover plate 455 can fit onto each side of the rotatable hub 454 (see FIG. 4).The threaded bolt 455B fits through a matching hole in the cover plate 455 and passes through a hole in the side of the rotatable hub 454 (see FIG. 4), exiting therefrom and capped by a lug 455C (see FIG. 4). The yoke pivot member 453 has threaded holes 448D formed in each end, into which a threaded bolt with a cap 448C can be threaded. The distal pivot member 443 can fit through a through hole 499C in the distal spar cap 499, with a channel 499E formed in its proximal face. The channel 499E is sized to receive the spar 404 and has a through hole 499B formed through its bottom face. The distal pivot member 443 can slide through the through hole 499C in the distal spar cap 499 and through a through hole 432D formed in the tang of the first clevis end 432A of the yoke 432. The distal pivot member 443 can further slide through a through-hole 499C in the distal spar cap 499. A threaded hole 443B is formed in the end of the distal pivot member 443. A collar 434 has a hole 434C formed in its center. A threaded bolt 434A can slide through the through-hole 434C in the collar 434 and thread into the threaded hole 443B formed in the end of the distal pivot member 443, securing the distal pivot member to the distal spar cap 499. The distal spar cap 499 has a channel 499E formed in its proximal surface that is sized to receive the spar 404. The channel 449E has a through-hole 499B formed through its bottom surface that corresponds to the space of the threaded hole 404A formed in the bottom surface of the spar 404. The spar 404 can fit into the channel 499E of the distal spar cap 499. A threaded bolt 499D can pass through a through hole 499B in the bottom surface of the distal spar cap 499 and threads into the threaded hole 404A to secure the spar 404 to the distal spar cap.

[0126] 4B illustrates several aspects of at least one embodiment of the present disclosure, including a polyaxial joint 441 with a primary clamp 421 having a hole 417 formed therein into which a graded stack or disc spring washer 412 can be inserted and covered with a cap 412A. A channel 425C is formed in the distal face of the clamp housing 425B and runs most of the length of the clamp housing. A yoke 432 attaches the polyaxial joint 441 to a distal pivot member 443. The distal pivot member 443 fits through a through-hole (not shown) in a matching distal spar cap 499. The distal spar cap 499 has a channel (not shown) into which the spar 404 can fit, thus attaching the spar of the frame 422 to the yoke 432.

[0127] FIG. 4C provides an illustration of several aspects of at least one embodiment of the present disclosure, including a yoke 432 having a first clevis end 432A and a second clevis end 432B. Through-holes 432D and 432C are formed in the tangs of the first clevis end 432A and the second clevis end 432B, respectively. The primary clamp 421 has a circular notch 423 formed therein, and a slot 422A is formed within a portion of its distal circumference. The slot 422A separates the upper clamp housing 425 from the lower clamp housing 425A. Section AA shows a side view of the distal side of the primary clamp 421, with the slot 422A separating the upper clamp housing 425 from the lower clamp housing 425A. A channel 425C is formed from the distal face of the lower clamp housing 425A and runs most of the length of the lower clamp housing. A through-hole 417 is formed in the top surface of the upper clamp housing 425, extends through the upper clamp housing, and penetrates the top surface of the lower clamp housing 425A, where it intersects with the channel 425C. The hemispheres 445 are sized so that their inner peripheries fit snugly around the outer periphery of the rotatable hub 454. The outer peripheries of the hemispheres 445 are sized to fit snugly within the inner surface of the circular cutout 423 of the primary clamp 421. The rotatable hub 454, with the hemispheres 445 fitted around its outer periphery, may be placed within the circular cutout 423 of the primary clamp 421. The rotatable hub 454 may have a hole formed in its center. The yoke pivot member 453 may slide through a through-hole 423C in the second clevis end 432B of the yoke 432. The yoke pivot member 453 can then slide through a central hole in the rotatable hub 454 as it rests inside the circular cutout 423 of the main clamp 421. Additionally, the other end of the yoke pivot member 453 can slide through a through hole 432C formed in a tang of the second clevis end 432B of the yoke 432. A cover plate 455 can fit onto each side of the rotatable hub 454. A threaded bolt 455B fits through aligned holes in the cover plate 455 and passes through a through hole 455A in the side of the rotatable hub 454 (see FIG. 4), where it can be capped by a lug 455C (see FIG. 4).The yoke pivot member 454 has a threaded hole 448D formed in each end, and a threaded bolt with a cap 448C can be threaded into the threaded hole. The distal pivot member 443 can fit through a through hole 449C in a distal spar cap 499, with a channel 499E formed in its proximal face. The channel 499E is sized to receive the spar 404 and has a through hole 499B formed through its bottom surface. The distal pivot member 443 can slide through the through hole 499C in the distal spar cap 499 and through a through hole 432D formed in the tang of the first clevis end 432A of the yoke 432. The distal pivot member 443 can further slide through a through hole 499C in the far spar cap 499. A threaded hole 443B is formed in the end of the distal pivot member 443. The collar 434 has a hole 434C formed in its center. A threaded bolt 434A can be slid through the through hole 434C in the collar 434 and threaded into a threaded hole 443B formed in the end of the distal pivot member 443 to secure the distal pivot member to the distal spar cap 499. A through hole 432D is formed through the distal and proximal faces of the first clevis end 432A of the yoke 432. A matching through hole 443E is formed through the distal pivot member 443. A double-threaded bolt 432 is fitted through the matching through hole 432E in the distal face of the second clevis end 432A, passes through a through hole in the distal pivot member 443, and is capped by a lug, thus securing the second clevis of the yoke to the distal pivot member.

[0128] As presented above, the combination of the rotational degrees of freedom of the rotating head, multi-axis joint, and yoke allows for matching degrees of freedom of movement between the frame and the surgical table, thereby minimizing the twisting and bending forces exerted by the frame and its spar members during use. This can prevent uncontrolled movement or even separation of the patient support device during a surgical procedure, while allowing for easy storage of accessories with minimal steps.

[0129] FIG. 5 provides details of an embodiment of an accessory including a proximal pivot member 591 that mounts within the proximal guard tube 580 and removably connects the second end of the frame 522 to the distal end of a surgical table (not shown). The proximal spur cap tube 561 has a coaxial bore 561D formed through its lateral and medial sides and also has a channel 561A formed in its distal side that is sized to receive the spur 504. The coaxial bore 561D is formed through the side of the proximal spur cap 561. The distal pivot member 560 has a bore formed in the distal region of its end. The proximal coupler 561 can slide over the proximal end region of the spur 504. The proximal coupler 561 can have an actuation button 561D that can be depressed to release the proximal pivot member 591 and adjust it outward or inward in the direction of arrow AA (see FIG. 11 for details). The proximal pivot member 591 can slide through a hole 561B formed through the proximal spar cap 561 and then out of hole 561B and into the proximal guard tube 580. A capture plate 560A with a hole 560R can fit over the end of the proximal pivot member 591 (see FIG. 11 for further details). A plate 560G with a hole in its center can be placed over hole 560R on the outside of capture plate 560A. A screw 560F can pass through the through hole in plate 560G and thread into a threaded hole 560J formed in the end of the proximal pivot member 591. A hole 560K in a collar 560T formed on the inside of capture plate 560A aligns with a hole 560K in the proximal pivot member 591, and a screw 560F inserted into the hole can secure the proximal pivot member 591 to the capture plate 560A. FIG. 11 provides additional details of the proximal pivot member / proximal guard tube assembly.

[0130] FIG. 6 illustrates another embodiment of the present disclosure, including a medial side view of a proximal clamp 650 comprised of a clamp body 651 with a table rail-receiving channel 652 formed through a portion of its length that fits over a surgical table side rail 653. The proximal clamp 650 has an opening (not shown) formed in its distal end that is sized to receive a proximal pivot member 691 and has a spring-loaded toggle arm 751C (see FIG. 7) that can pivot and lock the proximal pivot member 691 in place when actuated. The proximal pivot member 691 has a capture plate 680A attached to each end (see FIG. 6). Knobs 651A and 651B are attached to threaded studs 651P that fit into holes in the side of the proximal clamp 650 and, when tightened, can impinge on the surgical accessory rail 653 within the channel 652. Detail C of FIG. 6 is shown in more detail in FIG. 8, which provides details of the safety latch on the proximal clamp 651.

[0131] Figure 7 illustrates another embodiment of the invention, including several aspects of proximal clamp 751 from section BB of Figure 6. The aspects include an opening 751B formed in the distal end of proximal clamp 751 sized to receive proximal pivot member 760. Toggle arm 751C has a spring 751N that can release toggle arm 751C over a complementary proximal pivot member 791 within opening 751B. A surgical accessory rail 753 fits into channel 752, which is formed in the proximal end of proximal clamp 751 and runs most of the length of the proximal clamp.

[0132] FIG. 8 illustrates several aspects of one embodiment of the present disclosure, i.e., Detail C of FIG. 6 . Knobs 851A and 851B fit onto a threaded stud 851P and are held in place by a screw 851P inserted into a hole (not shown) in the knob. The threaded end of the threaded stud 851P fits into a hole (not shown) formed through the side of the proximal clamp 851. The threaded stud 851P of knob 851B can be rotated so that end 851Z impacts and presses against a first / outer side of a surgical accessory rail 853 that fits into a channel 852 formed in the distal end of the proximal clamp 851, thereby removably attaching / securing the proximal clamp 851 to the first / outer side of the surgical accessory rail 853. The intermediate view of FIG. 8 shows an opening 851U formed in the distal medial side of the proximal clamp 851. Rocker arm 851G, with through-hole 851L formed therethrough, fits over pin 851F. Pin 851F is placed and secured within a hole (not shown) formed within opening 851U. Clamp knob 851A has a threaded stud 851P attached to it by screw 851E, which threads into a hole (not shown) formed through the side of proximal clamp 851 and exits within opening 851U. The distal end of surgical accessory rail 853 fits within channel 852, which is formed within the proximal end of proximal clamp 851 and runs most of the length of the clamp. When knob 851A is tightened, its distal end abuts rocker arm 851, tilting it so that tip 851N extending from the rocker arm abuts the second / inner side of surgical accessory rail 853. This allows the fastening knobs mounted on the exterior of the accessory rail 853 to be used to generate a fastening force on both the outside and inside of the surgical accessory rail, thereby securely attaching the proximal clamp to the surgical accessory rail.

[0133] FIG. 9 provides an additional embodiment of the proximal clamp, namely, knob 951B. Knob 951B has a hole 951E on its underside into which a screw 981E fits to secure the knob to a threaded stud 951e with a flared end 951Z. The stud 951e fits into a hole (not shown) formed in the side of clamp body 951. Clamp body 951 has a channel 952 formed in its proximal end that runs most of the length of the clamp body. Clamp body 951 fits into and over channel 952. When knob 951B is rotated, flared end 951Z presses against rail 953 within channel 952, thereby locking clamp body 951 to rail 953.

[0134] FIG. 10 shows details of one embodiment of an accessory, a patient support device 1057, which is an example for an accessory support accessory. The patient support device 1057 includes a cushion 1061 attached to a support mount 1069, where a top plate 1069A is inclined at an angle Z from a generally horizontal line defined by PP, where angle Z may be between 10° and 60°. A channel 1064 is formed through the length of the support mount 1069 and is sized to fit over a spar (not shown) of a frame (not shown). A latch 1059 is spring-loaded by a spring 1059A biased against the spar (not shown) within the channel 1064, as illustrated in section AA, and is attached to the support mount 1069 by a pin 1059B. The latch 1059 is biased against the spar (not shown) within the channel 1064, thereby locking the support mount 1069 against movement of the patient support device 1057 along the spar.

[0135] 11 details an exploded view of the components of one aspect of one embodiment of the present invention. Spar 1104 has threaded holes 1104D formed in its bottom proximal surface. Section TT shows a view of proximal spar cap 1181 with rectangular holes 1181P formed in its top surface, holes 1181x formed in its central proximal bottom surface, and spaced-apart threaded holes 1181K formed in its distal bottom surface, as well as matching similar holes formed in the proximal region of the bottom surface of spar 1104.

[0136] The guard tube 1180 has a threaded hole 1180S formed through its wall. A threaded bolt 1180T with a lug can pass through hole 1181X and through hole 1180Y formed through the wall of the guard tube 1180 joining the proximal guard tube 1180 and the proximal spar cap 1181. Hole 1180Z is formed in the proximal face of the proximal spar cap 1181 and aligns with through hole 1180S formed through the end region of the guard tube 1180. A threaded bolt 1180T can pass through holes 1181X and 1180S and be capped by a lug, thereby securing the proximal guard tube 1180 to the proximal spar cap 1181.

[0137] The distal pivot members 1191 have threads formed within a portion of their circumference. A threaded hole 1191H is formed on the inner end of the proximal pivot member 1191. An internal collar 1192 can fit over the inner end of the proximal pivot member 1191, while a screw 1191A can pass through a hole in the internal collar and thread into the threaded hole 1191H. The inner end of the proximal pivot member 1191 can pass through a through channel 1181N in the proximal spar cap 1181 and slide into the guard tube 1180. An internal collar 1180Z can fit around the outer end of the proximal pivot member 1191 with the threaded hole 1191H. A screw with a flat head 1191A may be placed through a hole in the outer collar 1180Z, pass through hole 1180V, then through a hole in the capture plate 1180A, then through a hole in the inner collar 1180T, and threaded into hole 1180Q formed in the outer end of the proximal pivot member 1191, thus securing the capture plate to the proximal pivot member. The pivot member 1191 may slide through a channel 1181N formed through the lateral and medial sides of the proximal spur cap 1181. A biased spring latch assembly 1181L with a button 1181D may be placed into hole 1189P in the proximal spur cap 1181, thereby capturing the proximal pivot member 1191.

[0138] FIG. 12 illustrates several embodiments of the present disclosure, including a side cross-sectional view QQ from FIG. 5 of a biased actuator assembly 1281L when placed inside a hole (not shown) formed in a proximal region of the top proximal spar cap 1281.

[0139] Actuator button 1281D has threaded holes (not visible) formed in its bottom surface. Biasing rods 1281J may be threaded at their upper ends and screwed into threaded holes (not visible) in the bottom surface of actuator button 1281D.

[0140] View AA illustrates a bottom view of one embodiment of the proximal spar cap 1281, with the threaded bolt 1281G threaded into a threaded through hole (not visible) formed in the bottom surface of the spar cap 1281. The bottom surface of the spar cap 1281 also has a threaded hole 1281V formed therethrough. The bottom surface of the proximal region of the spar 1204 has a threaded hole 1204D formed therein, which aligns with threaded hole 1281H in the bottom surface of the proximal region of the proximal spar cap 1281. View AA shows the placement of the holes (not visible) and locations on the ends of the threaded bolts 1281G and 1281H.

[0141] Biasing block 1293 has a semicircular notch formed in its upper section shaped to receive the outer surface of proximal pivot member 1291. (See FIG. 13 for additional details.) Biasing block 1293 has a hole (not visible) in which a spring may be loaded, thus biasing the biasing block in the upward direction indicated by arrow B. Biasing rods 1281J have threaded holes formed through their lower ends, allowing threaded bolts 1281G to be inserted into holes 1281V in the bottom surface of proximal spar cap 1281, through holes (not visible) formed in the bottom of biasing actuator assembly 1281L, and into threaded holes formed in the lower ends of biasing rods 1281J. The biasing assembly is coupled to the proximal spar cap 1281 by threading a bolt 1281G through a hole 1281V in the bottom surface of the proximal spar 1281 and through a hole (not visible) in the bottom of the biasing actuator assembly 1281L and thus into a threaded hole formed in the bottom section of the biasing rod 1281J. Figure 13 provides additional details of one embodiment of the biasing actuator assembly 1281.

[0142] FIG. 13 provides another illustration of cross-sectional view QQ of FIG. 5 , including a proximal spar cap 1381 including a notch 1381U, and a bolt notch 1380 formed through its top surface and running the length of the bottom surface of the spar cap. The bolt 1381 may have a threaded hole 1381Q formed in its end bottom surface. The notch 1381U may be formed in the top surface of the proximal spar cap 1381 and sized to receive an actuator button 1381D. The actuator button 1381D may include a notch 1381P formed in its bottom surface sized to receive the top end of a bolt 1381J. The bolt 1381J may be placed in the bolt notch 1380, and a threaded bolt with a cap larger than the bolt notch may be threaded into the threaded hole 1381Q. The biased element has a notch 1396H formed therein that is sized to receive a portion of the circumference of the proximal pivot member 1391 and has a radius equal to the radius of the transverse bore 1396H formed through the width of the proximal spar cap 1381. A spring 1396A can be placed in a bore 1396B formed in the bottom of the biasing member 1396. The biasing member 1396 can be placed in a notch (not shown) formed in the bottom center surface of the transverse bore 1396H with the spring 1396A in the bore 1396B. It can be seen that when the proximal pivot member 1391 is placed through the transverse bore 1396H, the biasing member 1396 is biased upward by the spring 1396A, thereby locking its movement. Depressing or pushing downward on button 1381D releases biasing member 1396 from pushing on distal pivot member 1391, thereby allowing movement of the pivot member in the direction of arrow YY.

[0143] 14 provides some details of the attachment looking toward the distal end and base of the present invention. Base 1420 is supported by casters 1416, and frame trough 1424 is formed in its proximal anterior face. In this embodiment, support structure 1410 has adjustment columns 1427 and 1427A nested therein, which can extend upwardly away from the support structure or retract downwardly into the support structure.

[0144] Patient support device 1457 is an example of a patient support device. Patient support device 1457 can include a cushion 1461 attached to a support mount 1469, where a top plate 1469A is inclined at an angle Z from a generally horizontal line defined by PP, where angle Z can be 10° to 60°. A channel (not shown) is formed through the length of support mount 1469 and is sized to fit over spar 1404 that can slide thereover. Latch 1459 is spring loaded by a spring (not shown) biased against spar 1404 within the channel (not shown) to lock movement of patient support device 1457 along the spar. Polyaxial joint 1441 is coupled at its distal end to yoke 1432, while the proximal end of yoke 1432 is attached to the distal end of a frame (not shown).

[0145] Those skilled in the art will appreciate that various modifications can be made to the above embodiments without departing from the scope of the present invention.

[0146] The above detailed description refers to the accompanying drawings. The same or similar reference numbers may be used in the drawings or description to refer to the same or similar parts. Also, similarly named elements may perform similar functions and may be of similar design unless otherwise specified. Details have been described to provide an understanding of the exemplary embodiments. Embodiments, including alternative embodiments, may be practiced without some of these details. In other instances, well-known techniques, procedures, and components have not been described in detail to avoid obscuring the described embodiments.

[0147] The foregoing description of the embodiments has been presented by way of example only. It is not exhaustive and does not limit the embodiments to the precise form disclosed. While several exemplary embodiments and features have been described, modifications, adaptations, and other implementations may be possible without departing from the spirit and scope of the embodiments. Therefore, unless expressly stated otherwise, the description should not be construed as referring to one or more embodiments and as limiting the embodiments as a whole. This is true regardless of whether the disclosure describes a feature as referring to "a," "the," "one," "one or more," "some," or "various" embodiments. As used herein, the singular forms "a," "an," and "the" may include the plural unless the content clearly dictates otherwise. Furthermore, the term "coupled" does not exclude the presence of intermediate elements between the coupled items. Also, a statement that a feature may be present indicates that the feature may be present in one or more embodiments.

[0148] In this disclosure, the terms "include," "comprise," "contain," and "have," when used after a set or system, refer to an open-ended inclusion and do not exclude the addition of other unlisted members to the set or system. Furthermore, unless otherwise stated or otherwise deducted from the context, the conjunction "or," when used, does not exclude but instead includes the meaning of "and / or." Moreover, when these terms are used, a subset of a set may include one or more, including all members of the set.

[0149] Further, as used in this disclosure, and unless otherwise stated or deducted, a first variable is an increasing function of a second variable if the first variable does not decrease but instead generally increases when the second variable increases. Conversely, a first variable is a decreasing function of a second variable if the first variable does not increase but instead generally decreases when the second variable increases. In some embodiments, a first variable may be an increasing or decreasing function of a second variable if the first variable is directly or indirectly proportional to the second variable, respectively.

[0150] The disclosed systems, methods, and apparatus are not limited to any particular aspect or feature or combination thereof, or require that any particular advantage or problems be present or solved. Any theory of operation is for illustrative purposes only, and the disclosed systems, methods, and apparatus are not limited to such theory of operation.

[0151] Modifications and variations are possible in light of the above teachings or may be acquired from practice of the embodiments. For example, the described steps need not be performed in the same order as discussed, or divided to the same extent. Likewise, various steps may be omitted, repeated, combined, or performed in parallel as necessary to achieve the same or similar purpose. Likewise, the described systems need not necessarily include all components described in the embodiments, and may include other components not described in the embodiments. Accordingly, the embodiments are not limited to the details set forth above, but instead are defined by the appended claims in light of their full scope of equivalents. Moreover, the present disclosure is directed to all novel and unambiguous features and aspects of the various disclosed embodiments, both alone and in various combinations and subcombinations with each other.

[0152] While the present disclosure has been particularly described in conjunction with specific embodiments, many alternatives, modifications, and variations will become apparent in light of the foregoing description. It is therefore intended by the appended claims to cover all such alternatives, modifications, and variations as fall within the true spirit and scope of the present disclosure. [Explanation of symbols]

[0153] 102 Operating Table 104 Spar 108 Multi-axis coupling 109 Rotating Head 110 Flexible support structure 118 Proximal pivot member 122 frames 132 York 134 distal pivot member 204 Spar 206 Distal Mounting Cap 208 Multiaxial Coupling 210 Support Column 216 Caster 220 base 223 Caster locking part 224 Trough 226 Rotating locking head 227 Adjustment Column 228 Yoke collar 229 Locking Handle 232 York 233 Through Hole 262 Mounting plate 301 Top head plate 302 Operating Table 304 Spar 308 Multi-axis coupling 310 Support Column 311 Cam 313 Cam Block 316 Caster 320 base 321 Main Clamp 322 frames 323 Base 324 Storage Trough 325 circular notch 326 Rotating Head 327 Adjustment Column 329 Operating Handle 330 Ring bearing 332 York 334 Distal pivot member 335 Top plate 336 Bearing Aligner 337 packs 342 Mounting plate 349 Coupling Ring 351 Proximal pivot joint 357 Patient Support Devices 358 Cover 359 Threaded bolt 369 Bottom plate 370 Patient Support Devices 391 Proximal pivot member 399 Spur Coupler 404 Spar 408 Multi-axis coupling 412 Spring Laminated Washer 417 Through Hole 421 Main Clamp 422 frames 423 Circular notch 425 Upper Clamp Housing 432 York 434 Collar 441 Multi-axis Coupling Subassembly 443 Distal pivot member 445 hemisphere 448 Collar 449 Threaded Bolt 452 Half Moon Key 453 Yoke pivot member 454 Rotating Hub 455 Cover plate 456 Capture Elements 499 Distal Spur Cap 504 Spar 522 frames 560 distal pivot member 561 Proximal Spur Cap Tube 580 Proximal guard tube 591 Proximal pivot member 650 Proximal Clamp 651 Clamp body 652 Table rail receiving channel 653 Surgery Table Side Rail 691 Proximal pivot member 751 Proximal Clamp 752 channels 753 Surgery Accessory Rail 760 Proximal pivot member 791 Captured proximal pivot member 851 Proximal Clamp 852 channels 853 Surgery Accessory Rail 951 Clamp body 952 channels 953 Rail 1057 Patient support device 1059 Premium 1061 Cushion 1064 channels 1069 Support attachment part 1104 Spar 1180 Guard pipe 1181 Proximal Spur Cap 1191 distal pivot member 1192 Internal collar 1204 Spar 1281 Apical proximal spur cap 1291 Proximal pivot member 1293 energized block 1380 Bolt notch 1381 Proximal Spur Cap 1391 Proximal pivot member 1396 biasing member 1404 Spar 1410 Support Structure 1416 Caster 1420 base 1424 Frame Trough 1427 Adjustment Column 1432 York 1441 Multi-axis coupling 1457 Patient Support Devices 1459 stake 1461 Cushion 1469 Support attachment part

Claims

1. an accessory for attachment to a surgical table supporting at least a portion of a patient's body, the surgical table having a rectilinear frame capable of moving or articulating about six axes of rotation; at least one support structure having an adjustable length; a frame extending from a proximal end to a distal end, the distal end of the frame configured to be rotatably coupled to the surgical table; a multiaxial joint mounted on the at least one support structure rotatably coupled to the proximal end of the frame; and Including, The attachment, wherein the multi-axis joint has at least a first rotational degree of freedom about a tilt axis of the frame and a second rotational degree of freedom about an axis orthogonal to the tilt axis of the frame.

2. 2. The accessory of claim 1, wherein the frame includes two spar members each extending from the proximal end to the distal end of the frame, each spar member rotatably coupled at its distal end to the surgical table.

3. 3. The accessory of claim 2, further comprising a yoke configured to couple the polyaxial joint to the spar member such that the polyaxial joint can simultaneously rotate the yoke about the tilt axis of the frame and the axis orthogonal to the tilt axis of the frame.

4. 1. An accessory for attachment to a surgical table supporting at least a portion of a patient's body, comprising: at least one support structure having an adjustable height; a frame extending from a proximal end to a distal end, the distal end of the frame configured to be rotatably coupled to the surgical table; a multiaxial joint mounted on the at least one support structure, the multiaxial joint having at least three rotational degrees of freedom; a yoke having a proximal end coupled to the distal end of the multiaxial joint and a distal end rotatably coupled to the proximal end of the frame, wherein the coupling of the distal end of the multiaxial joint to the proximal end of the yoke enables the yoke to rotate about the at least three rotational degrees of freedom, thereby enabling the frame to rotate about the at least three rotational degrees of freedom; and Including accessories.

5. 5. The accessory of claim 4, further comprising a coupler pivotally and removably coupling the distal end of the frame to the surgical table such that the at least two spar members can move in response to movement of the surgical table and / or movement of the at least one support structure.

6. 5. The accessory of claim 4, wherein movement of said multi-axis joint about at least two of said at least three rotational degrees of freedom can be locked and unlocked simultaneously.

7. 1. An accessory for attachment to a surgical table supporting at least a portion of a patient's body, comprising: at least one support structure extending from a proximal end to a distal end, the proximal end of the at least one support structure being movable along a longitudinal axis of the support structure to adjust a length of the at least one support structure; a frame including at least two spar members each extending from a proximal end to a distal end, the distal end of each of the spar members being rotatably coupled to the surgical table; a multiaxial joint mounted to the proximal end of the support structure; a yoke rotatably coupled to the proximal end of one of the at least two spar members and to the proximal end of another of the at least two spar members such that the yoke is rotatable about an axis substantially perpendicular to the longitudinal axes of each of the spar members; Including, The multi-axis joint is coupled to the yoke and configured to allow the frame to rotate about a tilt axis while simultaneously rotating the yoke about an axis perpendicular to the tilt axis of the frame.

8. The accessory of claim 7 , further comprising a platform rigidly coupled to the distal end of the at least one support structure.

9. The accessory of claim 7 , wherein the at least one support structure comprises a retractable beam.

10. 10. The accessory of claim 1, wherein the frame is movable about six axes of rotation.

11. The accessory of claim 1 , further comprising a rotary locking head coupling the polyaxial joint to the support structure, the rotary locking head being rotatable about a longitudinal axis of the support structure.

12. 12. The accessory of claim 11, wherein the rotatable locking head includes a lever movable between a first position and a second position, wherein when the lever is in the first position, the rotatable locking head is rotatable and when the lever is in the second position, the rotatable locking head is locked against rotation.

13. 10. The accessory of claim 1, wherein the operating table allows the frame to move or articulate about six axes of rotation.

14. The accessory of claim 1 , wherein the frame is a rectilinear frame including a radiolucent member.

15. 2. The accessory of claim 1, further comprising a lockable rotary head attached to a top surface of the support structure, the rotary head configured to rotate about an axis perpendicular to the floor and running downwardly to the centers of the adjustment column and the support column and the floor, a distal portion of a multi-axis joint being coupled thereto.

16. 5. The accessory of claim 4, further comprising a lockable rotary head attached to the top surface of the support structure, the rotary head configured to rotate about an axis perpendicular to the floor and running downwardly to the centers of the adjustment column and the support column and the floor, a distal portion of a multi-axis joint being coupled thereto.

17. 8. The accessory of claim 7, further comprising a lockable rotary head attached to the top surface of the support structure, the rotary head configured to rotate about an axis perpendicular to the floor and running downwardly to the centers of the adjustment column and the support column and the floor, a distal portion of a multi-axis joint being coupled thereto.

18. 2. The accessory of claim 1, wherein the polyaxial joint includes a primary clamp having a circular notch formed therein, a rotatable hub having a through hole formed therein, a yoke pivot member configured to rotatably fit into the through hole, and a hemisphere disposed around a periphery of the rotatable hub and configured to be positioned within the circular notch, the yoke being rotatably coupled to the yoke pivot member such that the yoke can rotate about the yoke pivot member.

19. 5. The accessory of claim 4, wherein the polyaxial joint includes a primary clamp having a circular notch formed therein, a rotatable hub having a through hole formed therein, a yoke pivot member configured to rotatably fit into the through hole, and a hemisphere disposed around a periphery of the rotatable hub and configured to be positioned within the circular notch, the yoke being rotatably coupled to the yoke pivot member such that the yoke can rotate about the yoke pivot member.

20. 8. The accessory of claim 7, wherein the polyaxial joint includes a primary clamp having a circular notch formed therein, a rotatable hub having a through hole formed therein, a yoke pivot member configured to rotatably fit into the through hole, and a hemisphere disposed around a periphery of the rotatable hub and configured to be positioned within the circular notch, the yoke being rotatably coupled to the yoke pivot member such that the yoke can rotate about the yoke pivot member.

21. 1. An accessory for attachment to a surgical table supporting at least a portion of a patient's body, comprising: a surgical table capable of moving or articulating said rectilinear frame about six axes of rotation; at least one support structure having an adjustable length; a frame extending from a proximal end to a distal end, the distal end of the frame configured to rotatably couple to the surgical table; at least two or more joints mounted on the at least one support structure rotatably coupled to the proximal end of the frame, the at least two or more joints having at least a first rotational degree of freedom about a tilt axis of the frame and a second rotational degree of freedom about an axis perpendicular to the tilt axis of the frame; Including accessories.

22. 1. A clamp configured to attach to a surgical accessory rail having an outer side and an inner side, a clamp body having a table rail receiving channel formed therein configured to receive the surgical accessory rail, and first and second holes formed therein; first and second mating screws extending through the first and second holes, respectively; a first knob fitted onto the first threaded screw, such that rotation of the first knob causes an end of the first threaded screw to strike the outer side of the surgical accessory rail, thereby securing the clamp to the outer side of the surgical accessory rail; a rocker arm having a tip extending from the rocker arm; a second knob fitted onto the second engaging screw, wherein rotation of the second knob causes an end of the second engaging screw to strike the rocker arm, tilting the rocker arm and causing the surface of the tip to strike the inner side of the surgical accessory rail, thereby fixing the clamp to the inner side of the surgical accessory rail; and Including clamps.

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