Patient positioning system and method

Abstract

To provide systems for positioning a patient.SOLUTION: A system for positioning a patient comprises an upper support and a lower support. The upper support comprises: a mounting plate for a pad; a hinge with a curved surface including teeth, the curved surface operable to rotate; a pawl that is in contact with the teeth of the hinge, where the pawl is operable to allow rotation of the pad in a first direction due to angles of the teeth; a movable member extending from the hinge, the movable member including teeth; and a second pawl that is in contact with the teeth of the movable member, the second pawl operable to allow movement of the movable member due to angles of the teeth of the movable member. The lower support is connected to the upper support via the movable member.SELECTED DRAWING: Figure 1

Description

[Background technology]

[0001] Prone lumbar lateral approach interbody fusion (LLIF) can be performed with an open Jackson frame. However, traditional Jackson frames do not allow certain patient movements necessary to improve the approach and ergonomics of prone LLIF. In addition, anterior access to the psoas muscle (ATP) is also limited with traditional Jackson frames. In traditional lateral LLIF, surgeons often use a "break-the-bed" technique to create an angle between the ribs and the iliac crest. This opens up the space between the lumbar region and the ribs, improving access, especially for patients with challenging anatomy, such as L4-5 and L1-2. However, there is currently no way to controllably induce coronal adjustments on the patient when the patient is prone on a Jackson frame.

[0002] Lateral surgery in the prone position is often ergonomically poor. The height and tilt limitations of the Jackson frame, as well as the surgeon's height / body size, can reduce visibility of the surgical corridor and lead to unstable working angles. There is a need to improve surgeon ergonomics by allowing more control over patient height and tilt.

[0003] LLIF requires true anteroposterior (AP) and lateral C-arm imaging. Standard Jackson frames have a tilt angle of only about 25 degrees. With standard C-arm devices, with the patient on a tilted Jackson frame table, true lateral imaging is not possible until the table is tilted about 35 degrees. This is because to see a direct lateral image, the C-arm must "rainbow" over the patient by about 65 degrees or more, which many devices cannot do. However, by increasing the total patient tilt to about 40 to 45 degrees, the C-arm can rainbow over the patient to obtain a true lateral image. Thus, with conventional equipment, the surgeon must retilt the patient for each lateral fluoroscopic image.

[0004] An additional challenge with the prone lateral approach is that it currently does not allow for an oblique approach to the spine or an anterior psoas approach (ATP). The rails of the Jackson frame directly block the oblique trajectory required for proper ATP technique. Tilting the Jackson frame does not solve this problem, as the frame rails remain in the same position relative to the patient. There is a need to increase the patient's tilt relative to the rails of the Jackson frame to facilitate ATP approach. Summary of the Invention

[0005] In one exemplary embodiment, the present disclosure provides a patient positioning system including an upper support including a mounting plate for a pad, a hinge having a curved surface with teeth, the curved surface operable to rotate, a pawl that contacts the teeth of the hinge, the pawl operable to allow the pad to rotate in a first direction depending on the angle of the teeth, a movable member extending from the hinge, the movable member including teeth, and a second pawl that contacts the teeth of the movable member, the second pawl operable to allow the movable member to move depending on the angle of the teeth of the movable member, and a lower support connecting to the upper support via the movable member.

[0006] In one exemplary embodiment, the present disclosure provides a patient positioning system including an upper support including a pad attached to a mounting plate, a hinge having a curved ratchet operable to rotate the mounting plate, a pawl in contact with the curved ratchet operable to allow rotation in a first direction by a surface of the curved ratchet, a movable member extending from the hinge, the movable member including a linear ratchet, and a second pawl in contact with the linear ratchet operable to allow movement of the linear ratchet in a first direction, a lower support connected to the upper support via the movable member, and a frame, the lower support attached to the frame.

[0007] In one exemplary embodiment, the present disclosure provides a patient positioning system comprising an upper support including a pad for receiving a patient, a curved ratchet including teeth and operable to rotate the pad, a pawl in contact with the teeth of the curved ratchet and operable to allow the pad to rotate in a first direction by a surface of the curved ratchet, a movable member extending from the hinge, the movable member including a linear ratchet, and a second pawl in contact with the linear ratchet and operable to allow the linear ratchet to move in a first direction, a lower support connecting to the upper support via the movable member, the upper support including a second pad, and a frame, the lower support being attached to the frame.

[0008] It should be understood that both the foregoing general description, as well as the following detailed description, are exemplary and explanatory in nature and are intended to provide an understanding of the present disclosure without limiting the scope of the disclosure. In this regard, further aspects, features, and advantages of the present disclosure will become apparent to those skilled in the art from the following detailed description. [Brief description of the drawings]

[0009] These drawings illustrate certain aspects of some embodiments of the present disclosure and are not intended to limit or define the present disclosure. [Figure 1] 13A-13D illustrate a padding collapse assembly for positioning a patient according to certain embodiments of the present disclosure. [Figure 2A] 13 is a close-up view of the collapse assembly according to an embodiment of the present disclosure. [Figure 2B] 13 is a close-up view of the collapse assembly according to an embodiment of the present disclosure. [Figure 2C] 13 is a close-up view of the collapse assembly according to an embodiment of the present disclosure. [Figure 2D] 13 is a close-up view of the collapse assembly according to an embodiment of the present disclosure. [Figure 3A] FIG. 1 is a perspective view of a variable tilt and height adjustable jack according to an embodiment of the present disclosure. [Figure 3B] FIG. 1 is a perspective view of a variable tilt and height adjustable jack according to an embodiment of the present disclosure. [Figure 3C] FIG. 1 is a perspective view of a variable tilt and height adjustable jack according to an embodiment of the present disclosure. [Figure 3D] 10A-10C illustrate various configurations of the jack according to embodiments of the present disclosure. [Figure 3E] 10A-10C illustrate various configurations of the jack according to embodiments of the present disclosure. [Figure 3F] 10A-10C illustrate various configurations of the jack according to embodiments of the present disclosure. [Figure 4A] FIG. 1 illustrates an upper support and a lower support according to an embodiment of the present disclosure. [Figure 4B] FIG. 1 illustrates an upper support and a lower support according to an embodiment of the present disclosure. [Figure 4C] FIG. 13 illustrates the attachment of an upper support to a lower support according to an embodiment of the present disclosure. [Figure 4D] FIG. 13 illustrates the attachment of an upper support to a lower support according to an embodiment of the present disclosure. [Figure 4E] FIG. 13 illustrates the attachment of an upper support to a lower support according to an embodiment of the present disclosure. [Figure 4F] 13 illustrates an axial rotation mechanism according to an embodiment of the present disclosure. [Figure 4G] 13 illustrates an axial rotation mechanism according to an embodiment of the present disclosure. [Figure 4H] 13 illustrates an axial rotation mechanism according to an embodiment of the present disclosure. [Figure 5A] FIG. 1 illustrates a cranial / caudal hinge according to an embodiment of the present disclosure. [Figure 5B] FIG. 1 illustrates a cranial / caudal hinge according to an embodiment of the present disclosure. [Figure 5C] FIG. 1 illustrates a cranial / caudal hinge according to an embodiment of the present disclosure. [Figure 6A] FIG. 1 illustrates a cranial / caudal hinge according to an embodiment of the present disclosure. [Figure 6B] FIG. 1 illustrates a cranial / caudal hinge according to an embodiment of the present disclosure. [Figure 6C] FIG. 1 illustrates a cranial / caudal hinge according to an embodiment of the present disclosure. [Figure 7] 13A-13C illustrate plug-in locations for receiving locking features and hinge features according to an embodiment of the present disclosure. [Figure 8A] 11A-11C illustrate various locking positions of a pad mount and pad mount lock according to an embodiment of the present disclosure. [Figure 8B] 11A-11C illustrate various locking positions of a pad mount and pad mount lock according to an embodiment of the present disclosure. [Figure 8C] 11A-11C illustrate various locking positions of a pad mount and pad mount lock according to an embodiment of the present disclosure. [Figure 9A] FIG. 13 illustrates a front view of a hinge locking feature according to an embodiment of the present disclosure. [Figure 9B] FIG. 13 illustrates a front view of a hinge locking feature according to an embodiment of the present disclosure. [Figure 9C]FIG. 13 illustrates a front view of a hinge locking feature according to an embodiment of the present disclosure. [Figure 9D] FIG. 13 illustrates a front view of a hinge locking feature according to an embodiment of the present disclosure. [Figure 9E] FIG. 13 illustrates a front view of a hinge locking feature according to an embodiment of the present disclosure. [Figure 9F] FIG. 13 illustrates a front view of a hinge locking feature according to an embodiment of the present disclosure. [Figure 10A] 13A-13C illustrate various locking positions with hinge locking features including pad mounts for modularity according to an embodiment of the present disclosure. [Figure 10B] 13A-13C illustrate various locking positions with hinge locking features including pad mounts for modularity according to an embodiment of the present disclosure. [Figure 10C] 13A-13C illustrate various locking positions with hinge locking features including pad mounts for modularity according to an embodiment of the present disclosure. [Figure 11A] FIG. 1 illustrates a modular plate according to an embodiment of the present disclosure. [Figure 11B] FIG. 1 illustrates a modular plate according to an embodiment of the present disclosure. [Figure 12A] FIG. 13 illustrates an alignment feature of a pad mount according to an embodiment of the present disclosure. [Figure 12B] FIG. 13 illustrates an alignment feature of a pad mount according to an embodiment of the present disclosure. [Figure 12C] FIG. 13 illustrates an alignment feature of a pad mount according to an embodiment of the present disclosure. [Figure 12D] FIG. 13 illustrates an alignment feature of a pad mount according to an embodiment of the present disclosure. [Figure 13A] 12A-12D according to an embodiment of the present disclosure. FIG. [Figure 13B] 12A-12D according to an embodiment of the present disclosure. FIG. [Figure 13C] 12A-12D according to an embodiment of the present disclosure. FIG. [Figure 13D] 12A-12D according to an embodiment of the present disclosure. FIG. [Figure 14A] FIG. 1 illustrates an adjustable upper pad according to an embodiment of the present disclosure. [Figure 14B] FIG. 1 illustrates an adjustable upper pad according to an embodiment of the present disclosure. [Figure 15] FIG. 13 illustrates an upper support and a strap connecting them, according to an embodiment of the present disclosure. [Figure 16A] FIG. 13 illustrates a bolster with translational motion to accommodate various patient anatomies, according to an embodiment of the present disclosure. [Figure 16B] FIG. 13 illustrates a bolster with translational motion to accommodate various patient anatomies, according to an embodiment of the present disclosure. [Figure 17] 13A-13C show opposing bolsters that can include a multi-tooth lock that allows the slider portion to lock at any position within the slider track, according to an embodiment of the present disclosure. [Figure 18A] FIG. 13 illustrates a ratcheting mechanism for adjusting the bolster, according to an embodiment of the present disclosure. [Figure 18B] FIG. 13 illustrates a ratcheting mechanism for adjusting the bolster, according to an embodiment of the present disclosure. [Figure 19] FIG. 13 illustrates an alternative peg-in-slot locking mechanism for locking the translation of the bolster. [Figure 20] FIG. 13 illustrates an opposing bolster, also equipped with a depth stop, according to an embodiment of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0010] Reference will now be made to the implementations shown in the drawings and specific terms will be used to describe them for the purpose of promoting understanding of the principles of the present disclosure. It will be understood, however, that no limitation of the scope of the present disclosure is intended. Any changes and further modifications to the described devices, apparatus, methods, and further applications of the principles of the present disclosure are fully contemplated as would normally occur to one skilled in the art to which the present disclosure pertains. In particular, it may be fully contemplated that features, components, and / or steps described with reference to one or more implementations may be combined with features, components, and / or steps described with reference to other implementations of the present disclosure. For ease of description, the same reference numbers are used in some cases throughout the drawings to refer to the same or similar parts.

[0011] The embodiments relate generally to spinal surgery. More specifically, the embodiments relate to a system that collapses padding through a ramp connected to a screw. When a user turns the screw, the screw moves from side to side, which drives the ramp, forcing the padding to move along a track built into the base plate. Depending on the direction of the ramp, only one side (patient's left / right) can be collapsed at a time by controlling the screw to turn in either a clockwise or counterclockwise direction.

[0012] The assembly collapses the padding with ramps that connect to the screws. The screws are threaded into the assembly. When the user turns the screw, the screw moves left and right, driving each ramp and forcing the padding to move along the track built into the base plate. Alternatively, the screw can remain fixed and the threaded ramps can translate relative to the screw. Depending on the orientation of the ramps, only one side (patient's left / right) can be collapsed at a time, controlled by turning the screw in either a clockwise or counterclockwise direction. Because the ramps are not actuated by the screw, the padding can be at the bottom of the track. Because the ramps are actuated by the screw, the padding can move upwards into the track. The screw is rotated to move from left to right.

[0013] Regarding the tilt and height of the assemblies, the chest pad assembly and the lumbar pad assembly can each include a left and right jack, for a total of four jacks. Increasing the height of the left lumbar jack and the left thoracic jack will tilt the left side of the patient up. Similarly, raising both the right lumbar jack and the right thoracic jack will tilt the right side of the patient up. Raising all four jacks should only increase the height of the patient while keeping them at the same height as the bed frame.

[0014] In some embodiments, a handle is attached to the screw. Turning the handle turns the screw, which drives the actuator. As the actuator moves, it raises the height of the jack assembly. The top of the jack is provided with an adjustable end plate that allows the thoracic / lumbar pad assembly to match the height of the left or right jack. The jack can be lowered with zero degrees and no tilt. In some embodiments, one side may be tilted. Alternatively, the jack can be raised with no tilt.

[0015] Each padding collapse assembly can be attached to a frame (e.g., a Jackson frame, or other frame suitable for the procedure). The frame can extend longitudinally to accommodate / support the patient during the procedure. In some embodiments, the frame includes rails and can be manufactured from a rigid material such as, for example, metal or carbon fiber.

[0016] An upper support and a lower support may be attached to the frame. The lower support drives the coronal adjustment. Like the upper support, the lower support may have additional gripping features to aid in the actual movement of the patient's thoracic and lumbar regions with the respective pads. This is one method of securing the patient to the lower support. The gripping features may include pads that act to compress the patient's sides. In addition to providing anchoring to the lower support, the upper support also provides support when the frame is tilted and the patient's weight is placed on the tilted side.

[0017] Linear translation can occur on the upper support, meaning the pad can move inward and laterally to compress the patient side. The translation feature always allows for medial movement, while laterally it provides an automatic lock via a linear ratcheting system. This allows the user to compress the upper support without using redundant features. To release the ratcheting feature and allow the arm to translate freely, pull the handle or press the button. The linear ratchet slides in and out of the housing for shipping and modularity options (allowing the upper support to be easily removed from the lower support). Pulling the release handle allows the arm to be adjusted. The translation feature can utilize any form of locking, including peg-in-hole or crank. A locked configuration is one in which the pawl is in contact with the arm. An unlocked configuration is one in which the pawl is not in contact with the arm.

[0018] Axial pad rotation may also occur, allowing for "squeezing" for added patient safety. Rather than being locked at a single angle, the pad can be rotated toward the patient to provide additional downward pressure on the patient. The pivot feature always allows movement toward the patient, but provides an automatic lock when rotating away from the patient via a curved ratcheting system.

[0019] Similar to a linear ratchet, this allows the user to compress the upper support further without using an extra feature. To release the ratcheting feature, the handle is pulled to disengage the pawl. Alternatively, this feature can utilize a bayonet shaft that allows free rotation until engaged. A locked configuration is one in which the pawl is in contact with the ratchet. An unlocked configuration is one in which the pawl is not in contact with the ratchet.

[0020] Some examples include a cranial / caudal hinge, which allows the pad to be rotated toward or away from the head to move the pad mount out of the way of the anatomy (i.e. arms) or the surgeon's workspace. The pad mount is held securely in place until the handle is pulled to allow it to be rotated. When the handle is released, the hinge lock re-engages the pad mount in place. The hinge lock may be star-shaped so that the pad mount can be locked in many positions. The locked configuration is when the handle is not pulled and the hinge lock is locked. The unlocked configuration is when the handle is pulled and the hinge lock is unlocked.

[0021] The cephalad / caudal hinge allows for the inclusion of a modular pad mount. The cephalad / caudal hinge allows for the pad mount to be removable and modular. A locking feature (e.g., hinge lock) is inserted into the pad mount's plug-in location. When a button is pressed, the plug-in feature moves out of the way to allow the pad mount to pivot. When the button is released, the plug-in feature snaps back into the pad mount and locks into place.

[0022] To remove the pad mount from the main body, press the button (allowing it to rotate) and rotate the pad mount to a 90° position. This ensures that the hole in the pad mount is the same shape as the bayonet feature, allowing the lock to pass when the button is released. The pad mount can then be freely removed. There may be alignment features that help guide the pad mount into the correct position. The bayonet location and the hinged feature accept a locking feature. This feature can be rotated into position. There are various locking positions for the pad mount and the pad mount lock. The lock can be rotated to fit different parts of the mount.

[0023] A button can be pressed for adjustment / rotation. Locked configuration is when the button is not pressed. Unlocked configuration is when the button is pressed and can be rotated. There are various locking positions with a hinged locking feature, including the pad mount, for modularity. The mount and feature can be detached and assembled modularly. The feature can be rotated and placed on the mount. Modular plates are available. The button can be pressed to adjust the plate. The button can be pressed to lower the overall plate height. The pads can be adjusted with Velcro. The upper support can be joined with a strap. The support includes a slit that accepts a strap that connects to the other side to tighten the patient.

[0024] The bolster's translational movement allows it to accommodate different patient anatomies and also allows it to be tucked into the patient's side after the patient is on the bed to create (or reinforce) a coronal flexion. The translational movement has a locking feature that allows it to stay firmly in place once it is in the desired position. The locking feature can utilize a ratcheting component or it can utilize a "peg-in" feature, such as a peg-in-hole. The translational feature can utilize a "crank" that advances when a handle is turned, or a "screw." The bolster is attached to a table arm mount where it can be moved with a joint and locked into place.

[0025] The bolster is primarily made of radiolucent material so as not to interfere with X-ray imaging. The slider portion may be contained within the track or may be a separate, removable component. The slider is reversible so that it can be introduced into the track in either orientation. A reversible slider may include an offset pad support plate so that when introduced into the track in various orientations, the pad reach is increased or decreased to accommodate different sized patients. The opposing bolster may include a multi-tooth lock that allows the slider portion to lock in any position within the slider track. The multi-tooth may be controlled by a single button so that the user can unlock either (or both) locking pawl teeth by pressing a single unlock button.

[0026] The bolster can be adjusted using a ratcheting mechanism that can include metal teeth. Other components can be plastic. Additionally, the opposing bolster can include a depth stop to prevent the slider from extending too far along the track to a point where the locking teeth no longer engage the ratcheting components of the slider. The location of the depth stop can also be indicated by a line etched or otherwise marked on the track to visually indicate to the user when the slider is approaching or at the depth stop.

[0027] The opposing bolster may include removable padding. The pad may be attached with a dovetail or T-slot feature, hook-and-loop fastener (e.g., Velcro fastener), or other attachment mechanism. The opposing bolster may include a removable depth adjustment adapter that can be attached between the pad and the pad plate if the user requires additional distance (space). The adapter may be a radiolucent material that reduces interference with x-rays.

[0028] FIG. 1 illustrates a padding collapse assembly 100 according to certain embodiments of the present disclosure. The assembly 100 collapses padding (not shown) through ramps 102 connected to a screw 104 threaded into the assembly 100. When a user turns the screw 104, the screw 104 moves left and right, driving each ramp 102 and forcing the padding 103 to move along a track built into the base plate. Depending on the orientation of the ramps 102, only one side (patient's left / right) can be collapsed at a time by controlling the screw 104 to turn in either a clockwise or counterclockwise direction. Each ramp 102 may be located on an opposite side of the collapse assembly 100. Each ramp 102 may be of any suitable shape that provides a sloped surface.

[0029] Each padding collapse assembly 100 can be attached to a frame 106 (e.g., a Jackson frame, or other frame suitable for surgery). The frame 106 can extend longitudinally to accommodate / support a patient during surgery. In some embodiments, the frame includes rails and can be manufactured from a rigid material, such as, for example, metal. The frame 106 can include any suitable shape, such as, for example, rectangular.

[0030] 2A-2D show various positions of the ramp 102 during adjustment according to an embodiment of the present disclosure. FIG. 2A shows the bottom of the assembly 100. The assembly 100 collapses the padding 103 with the ramp 102 connecting to a screw 104. The ramp 102 may be positioned so that it can move on the screw 104. As mentioned above, the ramps 102 are positioned on opposite sides of the assembly 100 so that the ramp 102 can be adjusted from either side.

[0031] The screw 104 is threaded into the assembly 100. When a user turns the screw 104, the screw 104 moves side to side, driving each ramp 102 and forcing the padding 103 to move along a track 200 embedded in the base plate 202. The screw 104 may extend longitudinally along the base plate 202. The track 200 may include a slot in the base plate 202 that receives the padding 103. The padding may extend along the length of the screw 104 between the ramps 102.

[0032] 2B shows the top of the assembly 100 with the padding 103 in the bottom position. That is, the padding 103 can be in the bottom position of the track 200 because the ramp 102 is not actuated by the screw 104. Depending on the orientation of the ramp 102, only one side (patient's left / right) can be collapsed at a time by controlling the screw 104 to turn either clockwise or counterclockwise. Because the ramp 102 is not actuated by the screw 104, the padding 103 can be in the bottom position of the track 200.

[0033] FIG. 2C shows the bottom of the assembly 100 in an actuated position. Each ramp 102 can be adjusted via a screw 104 to provide a desired tilt of the padding 103. The ramps 102 are actuated by the screw 104, allowing the padding 103 to move upwards into the track 200. The screw 104 is rotated to move from left to right. FIG. 2D shows the top of the assembly 100 with the padding 103 in an actuated position. That is, the ramps 102 are actuated by the screw 104, allowing the padding 103 to move upwards into the track 200. The movement of only one ramp 102 may cause the padding 103 to tilt. However, based on the adjustment of the screw 104, the padding 103 can be adjusted / tilted as desired.

[0034] 3A-3F show various views of the tilt and height adjustment jacks 300. FIGS. 3A-3C show perspective views of the jacks 300. The chest pad assembly and the lumbar pad assembly can each include a left and right jack 300, for a total of four jacks. Increasing the height of the left lumbar jack and the left thoracic jack will tilt the left side of the patient up. Similarly, raising both the right lumbar jack and the right thoracic jack will tilt the right side of the patient up. Lifting all four jacks should only increase the height of the patient while keeping the patient at the same height as the bed frame.

[0035] 3A shows a housing 301 and a handle 302 attached to a screw 304 that is operable to move forward / inward and backward / outward relative to the housing 301. Turning the handle 302 turns the screw 304 which drives an actuator 306. As the actuator 306 moves, it raises the height of the jack assembly. The top of the jack is equipped with an adjustable end plate (not on model) that allows the thoracic / lumbar pad assembly to match the height of the left or right jack.

[0036] 3B and 3C, the jack 300 is rotated using the screw 304 to move the actuator 306 forward or backward depending on the direction the handle 302 is rotated. For example, turning the screw 304 clockwise pushes the actuator 306 forward, and turning the screw 304 in the opposite direction moves the actuator 306 backward. The members 308 and 310 can move in unison such that movement of the screw 304 actuates the pivotable members 308 and 310 to adjust the height of the jack.

[0037] Figures 3D-3F show various positions of jack 300. In Figure 3D, jack 300 is shown lowered with no tilt. Line 311 represents a tabletop angle of 0 degrees. Pivotable members 308 and 310 are generally flat and below line 311. With actuator 306 in a forward position, screw 304 has been rotated so that members 308 and 310 are flat below line 311.

[0038] FIG. 3E shows a single sided tilt, i.e., the left jack 300 is actuated. The pivotable members 308 and 310 on the left side are raised to provide the desired tilt. The actuator 306 has moved rearward to allow for the lift. Meanwhile, the pivotable members 308 and 310 on the right side remain flat and the actuator is pushed inward / forward relative to the housing 301. FIG. 3F shows the jack 300 raised with zero tilt, as indicated by line 311. The jack 300 can be optionally adjusted to allow for proper positioning. The pivotable members 308 and 310 are all raised to provide the desired tilt. The actuator 306 has moved rearward to allow for the lift. In some embodiments, the actuator 306 may move in and out of the housing 301 during adjustment of the jack 300.

[0039] 4A-4H show the upper support 400 and the lower support 402 of the frame 106. Meanwhile, the mechanisms of the chest pad and the lumbar pad have been described above. As can be seen in Fig. 4A and Fig. 4B, the lower support 402 is the driving source of the coronal adjustment, so there is a possibility that the positioner may slip under the patient.

[0040] To aid in the actual movement of the patient's thoracic and lumbar regions with the respective pads, gripping features can be added to the lower support, as can upper support 400. This is one way of securing the patient to lower support 402. The gripping features can include pads that function to compress the patient's sides. In addition to providing anchoring to lower support 402, upper support 400 also provides support when frame 106 is tilted and the patient's weight is placed on the tilted side. Both supports 400 and 402 can be attached to frame 106 via bracket 403 (see FIG. 4B).

[0041] 4B shows that a patient 405 may be positioned between upper supports 400 and lower supports 402. Each upper support 400 may be attached to an elongated member 407, such as a mounting plate. Member 407 may contact pin 429 that is pulled outward to allow vertical movement of upper support 400. Pin 429 may be pulled to allow member 407 to slide along track 409 below member 407. Pads 411 may be disposed on each of the upper and lower supports.

[0042] Each upper support 400 can include a pivotable member (e.g., hinge 408) to allow pivoting / rotation of the upper support 400 relative to the corresponding lower support 402. The hinge 408 can be coupled to the member 407 to allow the member 407 to rotate inward / outward relative to the patient 405. For example, a pin 410 can be pulled to unlock the hinge 408 to allow rotation of the member 407 (e.g., the mounting plate of each pad 411).

[0043] Then, after the desired pivoting of the upper support 400, the pin 410 can be moved forward to lock the position of the hinge 408 in place. Each of the lower supports 402 may be disposed adjacent to a movable member 412 that allows it to extend or retract in a linear direction. A plate 413 can be used to attach the lower supports 402. In some embodiments, the lower supports 402 do not pivot or extend / retract but are fixed in place. The lower supports 402 can be angled relative to the base plate via an angled structure 406.

[0044] Figures 4C-4E show the linear translation of the upper support 400. The pad can be moved medially and laterally to compress the patient's side. The translation feature only allows for medial movement, while laterally it provides an automatic lock via a linear ratcheting system.

[0045] 4C is a close-up view of the upper support 400. This allows the user to squeeze the upper support 400 without using redundant features. To release the ratcheting feature and allow the movable member 412 (e.g., arm) to translate freely, the pin 414 is pulled. The pin 414 can extend into a passageway 416 to lock the movable member 412 at a desired position within the passageway 416 (e.g., a housing that couples to the lower support 402). The movable member 412 (e.g., a linear ratchet) can include ridges / teeth 417. The movable member 412 and pin 414 can form a ratchet mechanism to linearly move / adjust the upper support 400.

[0046] The ratchet mechanism allows the upper support to move linearly inward or outward. The linear ratchet (movable member 412) slides in and out of the passageway 416 to facilitate removal of the upper support 400 from the lower support 402 during optional shipping and modularization. The release handle 420 can be pulled to adjust the movable member 412. This translation function can utilize any style of locking, including peg-in-holes or cranks.

[0047] FIG 4D shows a locked configuration in which the pawl 412 contacts the movable member 412. The pawl 422 may be located at the distal end of the pin 414. When engaged, the pawl 422 contacts the ridges / teeth 418 to lock the movable member 412 in place. FIG 4E shows an unlocked configuration in which the pawl 422 is not contacting the movable member 412. When the handle 420 is pulled, the pawl 422 moves away from (does not contact) the movable member 412, allowing linear movement of the movable member 412 through the passageway 416.

[0048] The linear movement of the movable member 412 is indicated by the directional arrow. In some embodiments, the ridges 418 may be angled and the pawl 422 may include a corresponding angle that only allows one-way movement of the movable member 412. As shown, the angle / contour prevents rearward movement unless the pin 414 is pulled to release / disengage the pawl 422 from the ridges / teeth 418.

[0049] 4F-H show axial pad rotation, which allows it to be "squeezed" for greater safety to the patient. Rather than being locked at a single angle (i.e., 90 degrees), the pad can be rotated toward the patient to provide more downward pressure on the patient. FIG. 4F illustrates a pivot feature (e.g., curved ratchet / hinge 408) that provides automatic locking when pivoting away from the patient via a curved ratcheting system, while always allowing movement toward the patient. Similar to a linear ratchet, this allows the user to further compress the upper support 400 without using redundant features. Pulling on the handle 410 allows the hinge 408, and thus the upper support 400, to pivot. A movable member 412 can extend from the hinge 408.

[0050] 4G shows a close-up view of the hinge 408 (e.g., a curved ratchet) in a locked configuration. To release the ratcheting function, the handle 410 is pulled to disengage the pawl 424 from the teeth 426 of the hinge 408. The hinge 408 may include a curved portion, such as a curved ratchet, with the teeth 426 extending at least partially along its circumference. The pawl 424 includes angled teeth 428 that correspond with the teeth 426 of the hinge 408 to allow rotation in one direction. This angle prevents reverse rotation until the pawl 424 is pulled away via the handle 410.

[0051] 4H shows an unlocked configuration where pawl 424 is not contacting ratchet / movable member 412. Pawl 424 includes an angled contact surface (tooth 428) that matches the angled contact surface of tooth 426, allowing rotation in one direction. Pulling handle 410 allows hinge 408 to rotate in the opposite direction. Unless pawl 424 disengages, hinge 408 remains fixed in position. Alternatively, this feature can utilize a bayonet shaft that allows free rotation until engaged.

[0052] 5A-5C show a cranial / caudal hinge 500. As seen in FIG. 5A, the hinge 500 can be pulled to unlock the pad mount 502. This allows the pad 503 to be rotated toward or away from the head, moving the pad mount 502 out of the way of the anatomy (i.e., arms) or the surgeon's workspace. The pad mount 502 is held securely in place until it can be rotated by pulling on the handle 504. The pad mount 502 can be any suitable shape, and in some embodiments, the shape may narrow toward the bottom of the pad mount 502. The hinge 500 can also include a housing 505 for internal components.

[0053] With further reference to FIG. 5B, when the handle 504 is released, the hinge lock 506 re-engages the pad mount 502 in place. The hinge lock 506 may be star-shaped so that the pad mount 502 can be locked in a number of positions. FIG. 5B shows a locked configuration where the handle 504 is not pulled and the hinge lock 506 is locked. That is, the member 506 coupled to the handle 504 prevents the pad mount 502 from pivoting. The member 507 is located within the housing 505. FIG. 5C shows an unlocked configuration where the handle 504 is pulled and the hinge lock 506 is unlocked. That is, the member 507 coupled to the handle 504 moves within the housing 505 to allow the pad mount 502 to pivot.

[0054] 6A-6C show a locking feature 600 of the cranial / caudal hinge (see FIGS. 5A-5C). The pad mount 502 can include a curved slot 601 to facilitate / guide movement of the pad mount 502. The locking feature 600 can include a keyhole 602 of any suitable shape (e.g., star-shaped).

[0055] With further reference to Figure 6B, another component of the locking feature 600 includes a key 603 that is inserted into a keyhole 602 to fix the position of the cranial / caudal hinge. Figure 6C illustrates that when a button 604 is pressed, the bayonet feature moves out of the way to allow the pad mount 502 to pivot. When the button 604 is released, the bayonet feature snaps back onto the pad mount 502, locking it into place.

[0056] FIG. 7 shows a lock 700 including an insertion position 701 and a keyway 702 for receiving a key 704. The key 704 can be rotated and positioned into the positions 701. Each position 701 includes a recess oriented at a different angle. The depth of each recess corresponds to the thickness of the key 704 to ensure a secure fit. FIGS. 8A-8C show various locking positions with the pad mount 502 and the lock 700. The lock 700 can be rotated to fit into the various positions. Various shapes of orifices can be used to receive the locking feature so that it can be adjusted to the desired angle. The key 704 is positioned in different positions within the position 701 in each of FIGS. 8A-8C. That is, the pad mount 502 is rotated and locked into place.

[0057] Figures 9A-9C show the front side of the hinge lock 700. Figure 9A shows the pad mount positioned in the lock 700. If desired, the pad 903 can be rotated and then locked into place. Figure 9B shows the locked configuration. The key 704 is placed in position 701 to secure the position of the pad mount 902. Figure 9C shows the unlocked configuration. The key 704 is pulled from position 701 to allow the pad mount 902 to rotate. The components of the lock may be located within a housing 907.

[0058] 9D-9F show the rear side of the hinge locking feature 700. The button 901 may be pressed to adjust / rotate the mount 902 holding the pad 903. FIG. 9E shows the locked configuration. The button 901 is not pressed to prevent the mount 902 from moving. The member 905 can be coupled to the button 901. The member 905 can extend into the button 901. FIG. 9F shows the unlocked configuration. The button 901 is pressed to allow rotation. The button 901 is not pressed to prevent the mount 902 from moving. Pressing the button 901 allows the mount 902 to rotate.

[0059] 10A-10C show various locking positions with a hinged locking feature 1000 including a pad mount 1002 for modularity. The mount 1002 and feature 1000 are removable and can be assembled in a modular manner. The feature 1004 can be rotated and placed in the mount 1002. Each component is separable and can be disassembled and assembled in a modular procedure. The mount 1002 can be rotated to accommodate various positions. Various shapes of orifices can be used to receive the locking feature to adjust to the desired angle. The feature 1000 is placed in different positions in the plug-in location 1006 in each of FIGS. 10A-10C. That is, the pad mount 1002 is rotated and locked in place.

[0060] 11A and 11B show a modular mounting plate 1100. Pressing a button 1102 allows the plate 1100 to be adjusted, i.e., the plate 1100 can be rotated. As seen in FIG. 11A, the plate 1100 is placed between the outer parts 1109 of a housing 1110. FIG. 11B shows the plate 1100 placed on a single outer part 1109 (e.g., the right or left part 1109) of the housing 1110. At the bottom of the housing 1110, a ratcheting mechanism 1111 is placed. For example, an arm 1113 with teeth 1115 can penetrate the housing 1110 to secure a component. A pad 1112 can be coupled to the plate 1100.

[0061] 12A-12D show alignment features of a pad mount, for example, pad mount 502. FIG. 12A shows misalignment of key 1200 with keyhole 1202. FIGS. 12B-12D show misalignment of key 1200 with keyhole 1202. Key 1200 can be a threaded set screw. Each component can be a rigid structure that allows keyhole 1202 to rotate. Keyhole 1202 includes a bayonet position that receives key 1200. Key 1200 can be rotated to position. Each position includes a recess oriented at a different angle. The depth of each recess corresponds to the thickness of the key to ensure a secure fit. FIGS. 12C and 12D show various locking positions with pad mount 502. Mount 502 can be rotated to fit various positions. Various shapes of orifices can be used to receive the locking features to allow adjustment to the desired angle. The key 1200 is placed in different positions within the keyway 1202 in each of Figures 12C and 12D, which means that the pad mount 502 is rotated and locked into place.

[0062] 13A-13D show cross-sectional views of FIGS. 12A-12D. The threads 1204 can extend along the key 1200. The key 1200 can extend through the housing 1110. The threads 1204 can extend along the locking key 1200. FIG. 13A shows misalignment of the key 1200 and the plate 502. FIGS. 13B-13D show the incremental alignment and positive placement of the key 1200 to the plate 502. The threads can be angled to facilitate movement. Additionally, the threads can provide grip. In some instances, the threads can allow movement in one direction and prevent movement backwards.

[0063] Figure 14A shows an adjustable upper pad 1400. Pad 1400 can be adjusted with Velcro 1401. Pad 1400 can be attached to a mount 1402. As seen in Figure 14B, arm 1402 can include a ratchet 1404 for lateral adjustment. Vertical adjustment uses handle 1406. Height and length can be adjusted as shown to allow for desired positioning.

[0064] In Figure 15, there is shown an upper support 1500 and a strap 1502 connecting them. The support 1500 includes slits 1501 that receive straps 1502 that connect to the other side to secure the patient. Pads 1504 can be placed between the supports 1500, which allows the patient to be immobilized. The straps can be tightened or loosened as needed.

[0065] 16A and 16B show a bolster 1600 that can be translated to accommodate various patient anatomies and also to allow the bolster 1600 to be tucked into the patient's side after the patient is on the bed to create (or reinforce) a coronary flexion. FIG. 16A shows the initial position of the bolster 1600. The translation has a locking feature 1602 that allows it to stay securely in place once it is in the desired position. For example, as described with respect to FIG. 19, the locking feature 1602 can utilize a ratcheting component or a "peg-in" feature, such as a peg-in-hole. The locking mechanism 1602 can include an arm 1603.

[0066] FIG. 16B illustrates the translation of the bolster 1600. The translation feature can utilize a "crank" or a "screw" that advances when a handle is turned. The bolster 1600 is attached to a table arm mount where it can be moved and locked into place with a joint. The bolster 1600 is made primarily of radiolucent material so as not to interfere with X-ray imaging. The slider portion 1604 may be contained within the track or may be a separate component that can be removed. The slider 1604 is reversible so that it can be introduced into the track 1606 in either orientation. A reversible slider can include an offset pad support plate that can be introduced into the track 1606 in various orientations to increase or decrease the pad reach to accommodate patients of various sizes.

[0067] 17 shows an opposing bolster 1700 that can include a multi-tooth lock 1701 that allows the slider portion 1702 to lock at any position within the slider track. The bolster 1700 can be used to firmly position the patient. The multi-tooth 1704 can be controlled by a single button 1705 such that the user can unlock either (or both) locking pawl teeth 1706 by pressing a single unlock button 1705. The bolster 1700 can move linearly.

[0068] 18A and 18B show a ratcheting mechanism 1800 for adjusting the bolster 1700. The mechanism 1800 may include metal teeth 1802 and teeth 1804. Teeth 1804 may extend along a movable member 1805. Member 1805 allows for linear movement of the bolster 1700. The various rows of teeth may contact one another to allow for adjustment. Other components may be made of plastic.

[0069] 19 shows that the opposing bolster 1900 may include a peg 1902 to prevent the slider 1904 from extending too far along the track to a position where the locking teeth will no longer engage the ratcheting components of the slider 1904. The location of the peg 1902 may be indicated by a line etched or otherwise marked in the track so that the user can visually tell when the slider 1904 is approaching or at a particular position. The peg 1902 may be used to lock the bolster 1700 in place. The bolster 1700 may include a frame 1906 for mounting pads 1907. The frame 1906 includes a lateral extension 1908 with holes 1909 for adjustment.

[0070] 20 shows the contralateral bolster 2000. The contralateral bolster 2000 can include a removable depth adjustment adapter 2004 that can be attached between the pad and pad plate if the user requires additional distance (space). The adapter 2004 can be a radiolucent material to reduce interference with x-rays. The teeth 2006 can extend along a movable member 2006 for linear movement. The member 2006 can be movably disposed within a track 2008. The track 2008 can be integral to a frame 2010.

[0071] The described embodiments allow for control of patient tilt and padding collapse during surgery using frames such as the Jackson frame.

[0072] Benefits may include padding collapse which improves lateral approach in prone position. Additionally, axial tilt during lateral approach is improved when the patient is in prone position. This axial tilt allows ATP approach in prone position. Padding collapse reduces scoliosis deformity due to positioning. Asymmetric axial tilt reduces axial rotation deformity due to positioning.

[0073] The operation and structure of the present disclosure will be apparent from the foregoing description. While the apparatus and methods shown and described above have been characterized as preferred, various changes and modifications are possible without departing from the spirit and scope of the present disclosure as defined in the following claims.

Claims

1. 1. A system for positioning a patient, comprising: a pair of upper supports spaced apart from one another and configured to support left and right sides, respectively, of the patient, each comprising: a mounting plate for the pad adapted to be placed on a corresponding side of the patient; a hinge having a curved surface with teeth, the curved surface being operable to pivot; a pawl in contact with the teeth of the hinge, the pawl operable to allow the pad to pivot in a first direction depending on the angle of the teeth; a movable member extending from the hinge, the movable member being a linear member including teeth, having a first end, and attached to the hinge such that the hinge pivots about the first end; a set of upper supports including a second pawl in contact with the teeth of the movable member, the second pawl operable to allow movement of the movable member depending on the angle of the teeth of the movable member; a lower support connected to each of said upper supports via said movable member.

2. 2. The system of claim 1, wherein the pawl includes an angled surface corresponding to the angle of the teeth, the pawl being operable to disengage from the hinge to allow pivoting in the opposite direction.

3. The system of claim 1 , wherein the pawl is disposed at a distal end of a pin.

4. The system of claim 3 , wherein the pin comprises a handle or a button.

5. 2. The system of claim 1, wherein the second pawl is disposed on a distal end of a second pin, the second pawl being operable to disengage from the movable member to allow retraction of the movable member.

6. The system of claim 1 , wherein the upper support further comprises a passageway operable to laterally receive the movable member.

7. The system of claim 1 further comprising the pad attached to the mounting plate.

8. The system of claim 1 , wherein the upper support further includes a passageway, the second pawl being disposed within the passageway.

9. The system of claim 1 , wherein the teeth extend along a periphery of the hinge.

10. The system of claim 1 , wherein the upper support is detachable from the lower support.

11. The system of claim 1 further comprising a frame, the underlying support being attached to the frame.

12. 1. A system for positioning a patient, comprising: a pair of upper supports spaced apart from one another and configured to support left and right sides, respectively, of the patient, each comprising: a pad attached to the mounting plate; a hinge having a curved ratchet, the curved ratchet operable to pivot the mounting plate; a pawl in contact with the curved ratchet, the pawl operable to be pivoted in a first direction by a surface of the curved ratchet; a movable member extending from the hinge, the movable member including a linear ratchet; a set of upper supports including a second pawl in contact with the linear ratchet, the second pawl operable to allow movement of the linear ratchet in a first direction; a lower support connected to the upper support via the movable member; a frame, the underlying support being attached to the frame.

13. 13. The system of claim 12, wherein the pawl includes an angled surface, the pawl operable to disengage from the curved ratchet to allow rotation in the opposite direction.

14. The system of claim 13 , wherein the pawl is disposed at a distal end of a pin.

15. 13. The system of claim 12, wherein the second pawl is disposed on a distal end of a second pin, the second pawl being operable to disengage from the linear ratchet to allow movement in the opposite direction.

16. The system of claim 12 , wherein the upper support is detachable from the lower support.

17. 1. A system for positioning a patient, comprising: a pair of upper supports spaced apart from one another and configured to support left and right sides, respectively, of the patient, each comprising: A pad for receiving a patient; a curved ratchet including teeth and operable to rotate the pad; a pawl in contact with the teeth of the curved ratchet, the pawl operable to allow the pad to rotate in a first direction with a surface of the curved ratchet; a movable member extending from the curved ratchet, the movable member including a linear ratchet; a set of upper supports including a second pawl in contact with the linear ratchet, the second pawl operable to allow movement of the linear ratchet in a first direction; a lower support connected to the upper support via the movable member, the upper support including a second pad; a frame, the underlying support being attached to the frame.

18. 20. The system of claim 17, wherein the pawl is operable to disengage from the curved ratchet to allow rotation in the opposite direction.

19. The system of claim 17 , wherein the second pawl is coupled to a handle.

20. The system of claim 17 , wherein the pawl includes an angled surface.

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