Patent Description:
Lateral surgery in the prone position often has poor ergonomics. Jackson frame height and tilt limitations, as well as surgeon height/stature may lead to reduced visualization of the surgical corridor and uncomfortable working angles. There is a need to improve surgeon ergonomics by increasing control over patient height and tilt.

LLIF requires true anteroposterior (AP) and lateral C-arm imaging. Standard Jackson frames only allow about <NUM> degrees of tilt. Standard C-arm devices are unable to achieve a true lateral shot with the patient on a tilted Jackson frame table, until about <NUM> degrees of table tilt. The reasoning for this is that to see a direct lateral image the C-arm would need to "rainbow" over the patient about <NUM> degrees or more, which many devices are incapable of doing. However, increasing total patient tilt to about <NUM> to <NUM> degrees allows a C-arm to get a true lateral image by rainbowing over the patient. Therefore, with existing equipment, the surgeon would need to de-tilt the patient for each lateral fluoro shot.

An additional challenge to prone position lateral access is that it currently does not allow for an oblique or Anterior-to-Psoas (ATP) approach to the spine. The Jackson frame rail directly blocks the oblique trajectory that would be needed for proper ATP technique. Tilting the Jackson frame does not solve this issue because the frame rail remains in the same position relative to the patient. There is a need to increase patient tilt relative to the Jackson frame rail to facilitate ATP access.

<CIT> and <CIT> describe systems known in the art.

According to the invention it is provided a positioning system for positioning a body having the features of claim <NUM>. Further advantageous aspects of the invention are set forth in the dependent claims.

In an exemplary embodiment, the present disclosure provides a patient positioning system comprising: an upper support comprising: a mounting plate for a pad; a hinge comprising a curved surface including teeth, the curved surface operable to rotate; a pawl that is in contact with the teeth of the hinge, wherein the pawl is operable to allow rotation of the pad in a first direction due to angles of the teeth; a moveable member extending from the hinge, the moveable member including teeth; and a second pawl that is in contact with the teeth of the moveable member, the second pawl operable to allow movement of the moveable member due to angles of the teeth of the moveable member; and a lower support connected to the upper support via the moveable member.

In another exemplary embodiment, the present disclosure provides a patient positioning system comprising: an upper support comprising: a pad attached to a mounting plate; a hinge comprising a curved ratchet, the curved ratchet operable to rotate the mounting plate; a pawl that is in contact with the curved ratchet, wherein the pawl is operable to allow rotation in a first direction due to a surface of the curved ratchet; a moveable member extending from the hinge, the moveable member including a linear ratchet; and a second pawl that is 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 moveable member; and a frame, wherein the lower support is mounted to the frame.

In another exemplary embodiment, the present disclosure provides a patient positioning system comprising: an upper support comprising: a pad for receiving a patient; a curved ratchet, the curved ratchet comprising teeth, the curved ratchet operable to rotate the pad; a pawl that is in contact with the teeth of the curved ratchet, wherein the pawl is operable to allow rotation of the pad in a first direction due to a surface of the curved ratchet; a moveable member extending from the hinge, the moveable member including a linear ratchet; and a second pawl that is 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 moveable member, the upper support comprising a second pad; and a frame, wherein the lower support is mounted to the frame.

In particular, even if reference is made to a patient, the positioning system of the invention could be used for supporting and positioning a body for different aims, for example during aesthetical activities, like massages or other.

These drawings illustrate certain aspects of some of the embodiments of the present disclosure and should not be used to limit or define the disclosure.

For the purposes of promoting an understanding of the principles of the present disclosure, reference will now be made to the implementations illustrated in the drawings and specific language will be used to describe them. It will nevertheless be understood that no limitation of the scope of the disclosure may be intended. Any alterations and further modifications to the described devices, instruments, methods, and any further application of the principles of the present disclosure are fully contemplated as would normally occur to one skilled in the art to which the disclosure relates. In particular, it may be fully contemplated that the features, components, and/or steps described with reference to one or more implementations may be combined with the features, components, and/or steps described with reference to other implementations of the present disclosure. For simplicity, in some instances the same reference numbers are used throughout the drawings to refer to the same or like parts.

Embodiments generally relate to spinal surgery. More particularly, embodiments relate to systems for breaking padding through a ramp connected to a screw. As a user turns the screw, the screw moves left or right, which drives the ramp that forces the padding along a track built into a base plate. Due to the orientation of the ramps, it is only possible to break one side (patient left/right) at a time, controlled by either clockwise or counterclockwise rotation of the screw.

The assembly breaks padding with ramps that are connected to a screw. The screw is threaded into the assembly. As a user turns the screw, the screw moves left or right, which drives each ramp that forces the padding along tracks built into a base plate. Alternatively, the screw may stay stationary and threaded ramps may translate relative to the screw. Due to the orientation of the ramp, it is only possible to break one side (patient left/right) at a time, controlled by either clockwise or counterclockwise rotation of the screw. The padding may be at the bottom position of the tracks because the ramps have not been actuated with the screw. The padding may move up the tracks because the ramps have been actuated with the screw. The screw has been rotated to move from left to right.

For tilt and height with the assembly, a chest pad assembly and hip pad assembly may each have a right and left jack, for four jacks total. By increasing the height of the hip left and chest left jack, the patient would tilt left side up. Similarly, increasing both the hip and chest right jacks would tilt the patient right side up. Lifting all four jacks would simply increase the height of the patient while keeping the patient level with the bed frame.

In some embodiments, a handle is attached to a screw. Turning the handle turns the screw, which drives the actuator. As the actuator moves, it lifts the jack assembly height. The top portion of the jack can have a variable endplate that allows the chest/hip pad assembly to match the left and right jack heights. The jack may be lowered with no tilt at zero degrees. In some examples, one side may be tilted. Or the jacks may be raised with zero tilt.

Each padding break assembly may be mounted to a frame (e.g., a Jackson frame or any other suitable frame for surgery). The frame may extend lengthwise to accommodate/support a patient during surgery. In some examples, the frame may include rails and may be made out of a rigid material such as for example, metal or carbon fiber.

Upper supports and lower supports may be attached to the frame. Lower supports drive the coronal break. To assist the actual movement of patient chest and hips with the respective pads, gripping features can be added to the lower supports such as upper supports. This is one way to fix the patient to the lower supports. The gripping features may have pads that have the functionality to compress on the patient's sides. In addition to providing fixation relative to the lower supports, the upper supports provide support as the frame is tilted and patient weight is applied to down tilted side.

Linear translational motion may occur for the upper support: ability to move the pads medially and laterally to compress on the patient's side. The translation feature always allows motion in the medial direction while providing self-locking in the lateral direction via a linear ratcheting system. This allows the user to compress the upper support without having to engage extra features. To release the ratcheting function and freely translate an arm, a handle is pulled or a button is pushed. The linear ratchet slides in and out of housing (easy removal of the upper support from the lower support) for shipping and modularity options. A release handle may be pulled to adjust the arm. This translation function can utilize any form of locking including peg-in-hole or crank. A locked configuration is where the pawl contacts the arm. An unlocked configuration is where the pawl does not contact the arm.

Axial pad rotation may also occur. This allows an ability to "squeeze" in for additional security to the patient. Rather than being locked at a single angle, the pads can rotate in toward the patient to apply additional pressure down toward the patient. The rotating feature always allows motion in the direction toward the patient while providing self-locking when rotating away from the patient via a curved ratcheting system.

Like the linear ratchet, this allows the user to compress the upper support further without having to engage extra features. To release the ratcheting function a handle is pulled which disengages a pawl. Alternatively, this feature could utilize a keyed shaft that provides free rotation until engaged. A locked configuration is where the pawl contacts the ratchet. An unlocked configuration is where the pawl does not contact the ratchet.

Some examples include a cephalad/caudal hinge. This allows an ability to rotate a pad toward or away from the head to move a pad mount out of the way of anatomy (i.e., arms) or surgeon working space. The pad mount is held rigidly until a handle is pulled, which allows rotation. When the handle is released, a hinge lock engages the pad mount back in place. The hinge lock may have a star shape so that the pad mount can lock in many positions. A locked configuration is where the handle has not been pulled and the hinge lock is locked. An unlocked configuration where the handle is pulled and the hinge lock is unlocked.

The cephalad/caudal hinge may include a modular pad mount. The cephalad/caudal hinge may allow for a pad mount to be removed for modularity. A locking feature (e.g., a hinge lock) is inserted into a keyed location on the pad mount. When a button is depressed, the keyed feature moves out of the way to allow rotation of the pad mount. When the button is released, the keyed featured snaps back to the pad mount to lock it in place.

To remove the pad mount from the body, the button is depressed (allowing rotation) and the pad mount is rotated to the <NUM>° position. This aligns a hole in the pad mount that has the same shape of the keyed feature, allowing the lock to pass when the button is released. The pad mount can then be freely removed. An alignment feature may be present that helps guide the pad mount to the right location. Keyed locations and a hinging feature receive a locking feature. The feature may be rotated for placement into the locations. There are different locking positions with a pad mount and a pad mount lock. The lock may be rotated to fit into different portions of the mount.

A button may be depressed for adjustment/rotation. A locked configuration is where the button has not been depressed. An unlocked configuration is where the button has been depressed to allow rotation. There are different locking positions with a hinge locking feature including a pad mount for modularity. The mount and the feature may be removed and assembled modularly. The feature may be rotated for placement into the mount. Modular plates may be employed. Depressing the button allows adjustment of the plate. The button is depressed to shorten the overall height of the plate. Pads may be adjustable with Velcro. Upper supports may be coupled by a strap. The supports include slits to accept the strap that connects it to the opposing side for cinching on the patient.

A bolster has translational movement so that it can accommodate varying patient anatomy and allow the user to push the bolster into the patient's side after they've been positioned on the bed to create (or enhance) the coronal bend. The translational movement will have a locking feature so that once it is placed in the desired position it will stay rigidly in place. The locking feature may utilize ratcheting components or may use a "key" feature like a peg in hole. The translation feature may utilize a "crank" or "screw" where it moves forward as a handle is turned. The bolster could be on a table arm mount where it can be moved on joints and locked into place.

The bolster is made out of primarily radiolucent materials so as not to disrupt x-ray imaging. The slider portion may be contained within the track or be a separate removeable component. The slider is reversible such that it can be introduced into the track in either orientation. The reversible slider may have an offset pad support plate such that when introduced to the track in different orientations, the reach of the pad is larger or smaller, accommodating patients of varying size. A contralateral bolster may have a multi-tooth lock to allow the slider portion to lock into position at any location within the slider track. The multiple teeth may be controlled by one unlocking button such that the user can depress one button to unlock either (or both) locking pawl teeth.

A ratcheting mechanism may be used for adjustment of the bolster. The mechanism may include teeth which are metal. Other components may be plastic. The contralateral bolster may also have a depth stop to prevent the slider from extending too far along the track, to a position in which no locking teeth are engaged with the ratcheting component of the slider. The location of the depth stop may also be indicated with an etched or otherwise marked line in the track to give the user visualization when the slider is approaching or at the depth stop location.

The contralateral bolster may have removable padding. The pads may be attached with a dovetail or t-slot feature, hook-and-loop fasteners (e.g., VELCRO fasteners), or other attachment mechanism. The contralateral bolster may include a removable depth adapter that can be attached between the pad and pad plate in the event that the user needs additional throw. The adapter may be a radiolucent material to reduce interference with x-rays.

<FIG> illustrates padding break assembly <NUM>, in accordance with particular embodiments of the present disclosure. The assembly <NUM> breaks padding (not shown) through a ramp <NUM> connected to a screw <NUM> thread into the assembly <NUM>. As a user turns the screw <NUM>, the screw <NUM> moves left or right, which drives each ramp <NUM> that forces the padding <NUM> along a track built into a base plate. Due to the orientation of the ramp <NUM>, it is only possible to break one side (patient left/right) at a time, controlled by either clockwise or counterclockwise rotation of the screw <NUM>. Each ramp <NUM> may be positioned on opposite sides of the break assembly <NUM>. Each ramp <NUM> may be of any suitable shape to provide an inclined surface.

Each padding break assembly <NUM> may be mounted to a frame <NUM> (e.g., a Jackson frame or any other suitable frame for surgery). The frame <NUM> may extend lengthwise to accommodate/support a patient during surgery. In some examples, the frame may include rails and may be made out of a rigid material such as for example, metal. The frame <NUM> may include any suitable shape such as for example, a rectangle.

<FIG> illustrates different positions of the ramp <NUM> during adjustment, in accordance with examples of the present disclosure. <FIG> illustrates the bottom of the assembly <NUM>. The assembly <NUM> breaks padding <NUM> with ramps <NUM> that are connected to a screw <NUM>. The ramps <NUM> may be movably disposed on the screw <NUM>. As noted above, the ramps <NUM> are disposed on opposite sides of the assembly <NUM> to allow for adjustment of the ramps <NUM> from either side.

The screw <NUM> is thread into the assembly <NUM>. As a user turns the screw <NUM>, the screw <NUM> moves left or right, which drives each ramp <NUM> that forces the padding <NUM> along tracks <NUM> built into a base plate <NUM>. The screw <NUM> may extend lengthwise along the base plate <NUM>. The tracks <NUM> may include slots in the base plate <NUM> to receive the padding <NUM>. The padding may extend along a length of the screw <NUM> between the ramps <NUM>.

<FIG> illustrates the top of the assembly <NUM> with the padding <NUM> in the bottom position. That is, the padding <NUM> is at the bottom position of the tracks <NUM> because the ramps <NUM> have not been actuated with the screw <NUM>. Due to the orientation of the ramp <NUM>, it is only possible to break one side (patient left/right) at a time, controlled by either clockwise or counterclockwise rotation of the screw <NUM>. The padding <NUM> is at the bottom position of the tracks <NUM> because the ramps <NUM> have not been actuated with the screw <NUM>.

<FIG> illustrates the bottom of the assembly <NUM> in an actuated position. Each ramp <NUM> may be adjusted via the screw <NUM> to provide desired inclination of the padding <NUM>. The padding <NUM> has moved up the tracks <NUM> because the ramps <NUM> have been actuated with the screw <NUM>. The screw <NUM> has been rotated to move from left to right. <FIG> illustrates the top of the assembly <NUM> with the padding <NUM> in the actuated position. That is, the padding <NUM> has moved up the tracks <NUM> because the ramps <NUM> have been actuated with the screw <NUM>. The padding <NUM> may be inclined due to movement of only one ramp <NUM>. However, the padding <NUM> may be adjusted/inclined as desired based on adjustment of the screw <NUM>.

<FIG> illustrate various views of a jack(s) <NUM> for tilt and height adjustments. <FIG> illustrate perspective views of the jack <NUM>. A chest pad assembly and hip pad assembly may each have a right and left jack <NUM>, for four jacks total. By increasing the height of the hip left and chest left jack, the patient would tilt left side up. Similarly, increasing both the hip and chest right jacks would tilt the patient right side up. Lifting all four jacks would simply increase the height of the patient while keeping the patient level with the bed frame.

<FIG> illustrates a housing <NUM> and a handle <NUM> that is attached to a screw <NUM> that is operable to move forward/inward and backward/outward, relative to the housing <NUM>. Turning the handle <NUM> turns the screw <NUM>, which drives an actuator <NUM>. As the actuator <NUM> moves, it lifts the jack assembly height. The top portion of the jack can have a variable endplate (not in model) that allows the chest/hip pad assembly to match the left and right jack heights.

As shown on <FIG>, the jacks <NUM> employ the screw <NUM> to rotate and move the actuator <NUM> forward or backward depending on direction of rotation of the handle <NUM>. For example, as the screw <NUM> is rotated clockwise, the actuator <NUM> is pushed forward and when the screw <NUM> is rotated in the opposite direction, the actuator <NUM> is moved backwards. Pivotable members <NUM> and <NUM> may move in concert such that movement of the screw <NUM> actuates the members <NUM> and <NUM> to adjust height of the jack.

<FIG> illustrate various positions of the jacks <NUM>. <FIG> illustrates the jack <NUM> lowered with no tilt. Line <NUM> represents a table-top angle that is at zero degrees. Pivotable members <NUM> and <NUM> are generally flat and are below the line <NUM>. The screw <NUM> has been rotated such that the actuator <NUM> is in a forward position and the members <NUM> and <NUM> are pivoted to lie flat below the line <NUM>.

<FIG> illustrates one side tilt. That is, the left jack <NUM> has been actuated. The pivotable members <NUM> and <NUM> on the left are elevated to provide inclination as desired. The actuator <NUM> has moved backward to provide the elevation. Whereas on the right side, the pivotable members <NUM> an\d <NUM> remain flat with the actuator pushed inward/forward relative to the housing <NUM>. <FIG> illustrates the jacks <NUM> raised with zero tilt as shown with the line <NUM>. The jacks <NUM> are adjustable as desired to provide proper positioning. All of the pivotable members <NUM> and <NUM> are elevated to provide inclination as desired. The actuators <NUM> are moved backward to provide the elevation. In some examples, the actuators <NUM> may travel into and out of the housing <NUM> during adjustment of the jacks <NUM>.

<FIG> illustrates upper supports <NUM> and lower supports <NUM> for the frame <NUM>. While the mechanism in the chest and hip pads described above. As shown on <FIG> and <FIG>, lower supports <NUM> is what drives the coronal break, it is possible that the positioners slip under the patient. Upper supports <NUM> and lower supports <NUM> each comprise a plurality of supports, preferably two supports.

To assist the actual movement of patient chest and hips with the respective pads, gripping features can be added to the lower supports such as upper supports <NUM>. This is one way to fix the patient to the lower supports <NUM>. The gripping features may have pads that have the functionality to compress on the patient's sides. In addition to providing fixation relative to the lower supports <NUM>, the upper supports <NUM> provide support as the frame <NUM> is tilted and patient weight is applied down the tilted side. Both supports <NUM> and <NUM> may be attached to the frame <NUM> via brackets <NUM> (see <FIG>).

<FIG> illustrates that a patient <NUM> may be disposed between the upper supports <NUM> and the lower supports <NUM>. Each upper support <NUM> may be attached an elongated member <NUM> such as a mounting plate. The member <NUM> may be in contact with a pin <NUM> which may be pulled outward to allow vertical movement of the upper support <NUM>. The pin <NUM> may be pulled allowing the member <NUM> to slide along a track <NUM> below the member <NUM>. Pads <NUM> may be disposed on each of the upper and lower supports.

Each upper support <NUM> may include a rotatable member (e.g., a hinge <NUM>) to allow pivoting/rotation of the upper support <NUM> relative to the corresponding lower support <NUM>. The hinge <NUM> may be coupled to the member <NUM> allowing inward/outward rotation of the member <NUM> to/from the patient <NUM>. For example, a pin <NUM> may be pulled to unlock the hinge <NUM> thereby allowing rotation of the member <NUM> (e.g., a mounting plate for each pad <NUM>).

The pin <NUM> may then be moved forward to lock the position of the hinge <NUM> in place after desired rotation of the upper support <NUM>. The lower supports <NUM> may each be disposed adjacent to the moveable member <NUM> that may extend or retract in a linear direction. A plate <NUM> may be used to mount the lower supports <NUM>. In some examples, the lower supports <NUM> do not rotate nor extend/retract and are fixed in place. The lower supports <NUM> may be angled relative to the base plate via angled structures <NUM>.

The lower supports are attached to the plate <NUM>. Preferably the lower supports <NUM> stay in position in relation to the plate <NUM> and the moveable member <NUM> is movable for moving the upper supports <NUM> and adjust the position of the upper supports <NUM> in relation to the lower supports <NUM>. The upper supports are translatable in relation to the lower supports <NUM>.

The movable member <NUM> allows the upper supports <NUM> to be moved in relation to the lower supports <NUM>.

<FIG> illustrates linear translational motion for the upper support <NUM>. Ability to move the pads medially and laterally to compress on the patient's side. The translation feature always allows motion in the medial direction while providing self-locking in the lateral direction via a linear ratcheting system.

<FIG> illustrates a close-up view of the upper support <NUM>. This allows the user to compress the upper support <NUM> without having to engage extra features. To release the ratcheting function and freely translate the moveable member <NUM> (e.g., an arm), a pin <NUM> is pulled. The pin <NUM> may extend into a passage <NUM> to secure the moveable member <NUM> within the passage <NUM> (e.g., housing coupled to the lower support <NUM>) at a desired position. The moveable member <NUM> (e.g., a linear ratchet) may include ridges/teeth <NUM>. The moveable member <NUM> and the pin <NUM> may form a ratchet mechanism for linear movement/adjustment of the upper support <NUM>.

The ratchet mechanism allows the upper support to move linearly inward or outward as desired. The linear ratchet (the moveable member <NUM>) slides in and out of the passage <NUM> to facilitate removal of the upper support <NUM> from the lower support <NUM> during shipping and modularity options. A release handle <NUM> may be pulled to adjust the moveable member <NUM>. This translation function can utilize any form of locking including peg-in-hole or crank.

<FIG> illustrates a locked configuration where a pawl <NUM> contacts the moveable member <NUM>. The pawl <NUM> may be disposed on a distal end of the pin <NUM>. When engaged, the pawl <NUM> contacts the ridges/teeth <NUM> to secure the moveable member <NUM> in place. <FIG> illustrates an unlocked configuration where the pawl <NUM> does not contact the moveable member <NUM>. As the handle <NUM> is pulled, the pawl <NUM> moves away (no contact) from the moveable member <NUM> to allow linear movement of the moveable member <NUM> through the passage <NUM>.

Linear movement of the moveable member <NUM> is shown by the directional arrows. In some examples, the ridges <NUM> may be angled and the pawl <NUM> may include a corresponding angle to allow only one way movement of the moveable member <NUM>. As shown, the angles/profiles prevent backward movement unless the pin <NUM> is pulled to release/disengage the pawl <NUM> from the ridges/teeth <NUM>.

<FIG> illustrates axial pad rotation. This allows an ability to "squeeze" in for additional security to the patient. Rather than being locked at a single angle (i.e., <NUM>°), the pads can rotate in toward the patient to apply additional pressure down toward the patient. <FIG> illustrates the rotating feature (e.g., curved ratchet/ hinge <NUM>) that always allows motion in the direction toward the patient while providing self-locking when rotating away from the patient via a curved ratcheting system. Like the linear ratchet, this allows the user to compress the upper support <NUM> further without having to engage extra features. The handle <NUM> may be pulled to allow rotation of the hinge <NUM> and the upper support <NUM>. The moveable member <NUM> may extend from the hinge <NUM>.

<FIG> illustrates a close-up view of the hinge <NUM> (e.g., curved ratchet) in a locked configuration. To release the ratcheting function, the handle <NUM> is pulled which disengages a pawl <NUM> from teeth <NUM> of the hinge <NUM>. The hinge <NUM> may include a curved portion with the teeth <NUM> extending at least partially along its circumference such as a curved ratchet. The pawl <NUM> may include angled teeth <NUM> to correspond with the teeth <NUM> of the hinge <NUM> to provide one way rotation. The angles prevent opposite rotation until the pawl <NUM> is pulled away via the handle <NUM>.

<FIG> illustrates an unlocked configuration where the pawl <NUM> does not contact the ratchet/moveable member <NUM>. The pawl <NUM> may include an angled contact surfaces (teeth <NUM>) that corresponds with the angled contact surfaces of the teeth <NUM> to provide one way rotation. The handle <NUM> may be pulled to rotate the hinge <NUM> in the opposite direction. Unless the pawl <NUM> is disengaged, the position of the hinge <NUM> is secure. Alternatively, this feature could utilize a keyed shaft that provides free rotation until engaged.

<FIG> illustrate a cephalad/caudal hinge <NUM>. As shown on <FIG>, the hinge <NUM> may be pulled to unlock a pad mount <NUM>. This allows an ability to rotate a pad <NUM> toward or away from the head to move the pad mount <NUM> out of the way of anatomy (i.e., arms) or surgeon working space. The pad mount <NUM> is held rigidly until a handle <NUM> is pulled, which allows rotation. The pad mount <NUM> may be of any suitable shape and in some examples, the shape may narrow toward the bottom of the pad mount <NUM>. The hinge <NUM> may also include a housing <NUM> for internal components.

With additional reference to <FIG>, when the handle <NUM> is released, a hinge lock <NUM> engages the pad mount <NUM> back in place. The hinge lock <NUM> may have a star shape so that the pad mount <NUM> can lock in many positions. <FIG> shows a locked configuration where the handle <NUM> has not been pulled and the hinge lock <NUM> is locked. That is, a member <NUM> coupled to the handle <NUM> blocks the pad mount <NUM> from rotating. The member <NUM> is disposed within the housing <NUM>. <FIG> illustrates an unlocked configuration where the handle <NUM> is pulled and the hinge lock <NUM> is unlocked. That is, the member <NUM> that is coupled to the handle <NUM> is moved within the housing <NUM> such that the pad mount <NUM> is able to rotate.

<FIG> illustrate a locking feature <NUM> for the a cephalad/caudal hinge (see <FIG>). The pad mount <NUM> may include a curved slot <NUM> to facilitate/guide movement of the pad mount <NUM>. The locking feature <NUM> may include a keyhole <NUM> of any suitable shape (e.g., star-like).

With additional reference to <FIG>, another component of the locking feature <NUM> includes a key <NUM> that is placed into the keyhole <NUM> to secure a position of the cephalad/caudal hinge. <FIG> illustrates when a button <NUM> is depressed, the keyed feature moves out of the way to allow rotation of the pad mount <NUM>. When the button <NUM> is released, the keyed featured snaps back to the pad mount <NUM> to lock it in place.

<FIG> illustrates a lock <NUM> including keyed locations <NUM> and a keyhole <NUM> for receiving a key <NUM>. The key704 may be rotated for placement into the locations <NUM>. Each location <NUM> includes recesses that are oriented at a different angle. The depth of each recess corresponds with the thickness of the key <NUM> to ensure a secure fit. <FIG> illustrate different locking positions with the pad mount <NUM> and the lock <NUM>. The lock <NUM> may be rotated to fit into different positions. Variously shaped orifices may be employed to receive the locking features to allow desired angles for adjustment. The key <NUM> is positioned differently within the locations <NUM> in each of <FIG>. That is the pad mount <NUM> has been rotated and locked into place.

<FIG> illustrate a front side of a hinge lock <NUM>. <FIG> illustrates a pad mount disposed in the lock <NUM>. The pad <NUM> may be rotated as desired then locked in place. <FIG> shows a locked configuration. The key <NUM> is placed within the location <NUM> to secure position of the pad mount <NUM>. <FIG> illustrates an unlocked configuration. The key <NUM> is pulled from the location <NUM> to allow rotation of the pad mount <NUM>. Components of the lock may be disposed in a housing <NUM>.

<FIG> illustrate a back side of a hinge locking feature <NUM>. A button <NUM> may be depressed for adjustment/rotation of the mount <NUM> holding the pad <NUM>. <FIG> shows a locked configuration. The button <NUM> has not been depressed to block travel of the mount <NUM>. A member <NUM> may be coupled to the button <NUM>. The member <NUM> may extend into the button <NUM>. <FIG> illustrates an unlocked configuration. The button <NUM> has been depressed to allow rotation. The button <NUM> has not been depressed to block travel of the mount <NUM>. Upon depression of the button <NUM>, rotation of the mount <NUM> may occur.

<FIG> illustrate different locking positions with a hinge locking feature <NUM> including a pad mount <NUM> for modularity. The mount <NUM> and the feature <NUM> may be removed and assembled modularly. The feature <NUM> may be rotated for placement into the mount <NUM>. Each of the components are separable to allow disassembly and assembly as a modular procedure. The mount <NUM> may be rotated to fit into different positions. Variously shaped orifices may be employed to receive the locking features to allow desired angles for adjustment. The feature <NUM> is positioned differently within the keyed locations <NUM> in each of <FIG>. That is, the pad mount <NUM> has been rotated and locked into place.

<FIG> show modular mounting plates <NUM>. Depressing the button <NUM> allows adjustment of the plate <NUM>. That is, the plate <NUM> may be rotated. As shown on <FIG>, the plate <NUM> is disposed between outer portions <NUM> of a housing <NUM>. <FIG> illustrates the plate <NUM> disposed on a single outer portion <NUM> of the housing <NUM> (e.g., right or left portion <NUM>). A ratcheting mechanism <NUM> is disposed at the bottom of the housing <NUM>. For example, an arm <NUM> with teeth <NUM> may extend through a housing <NUM> that secures the components. Pads <NUM> may be coupled to the plates <NUM>.

<FIG> illustrate an alignment feature for a pad mount, for example, pad mount <NUM>. <FIG> shows malalignment of the key <NUM> with the keyhole <NUM>. <FIG> show aligning of the key <NUM> with the keyhole <NUM>. Key <NUM> may be a set screw having threads. Each of the components may be rigid structures that allow for rotation of the keyhole <NUM>. Keyhole <NUM> includes keyed locations for receiving key <NUM>. The key <NUM> may be rotated for placement into the locations. Each location includes recesses that are oriented at a different angle. The depth of each recess corresponds with the thickness of the key to ensure a secure fit. <FIG> illustrate different locking positions with the pad mount <NUM>. The mount <NUM> may be rotated to fit into different positions. Variously shaped orifices may be employed to receive the locking features to allow desired angles for adjustment. The key <NUM> is positioned differently within keyhole <NUM> each of <FIG>. That is, the pad mount <NUM> has been rotated and locked into place.

<FIG> illustrate cross-sectional views of <FIG>. Threads <NUM> may extend along the key <NUM>. The key <NUM> may extend through the housing <NUM>. Threads <NUM> may extend along the locking key <NUM>. <FIG> shows malalignment of the key <NUM> with the plate <NUM>. <FIG> show progressive aligning of the key <NUM> with the plate <NUM> to secure placement thereof. The threads may be angled to facilitate travel. The threads may also provide grip. The threads may allow one-way movement and may prevent backward movement in some examples.

<FIG> shows an adjustable upper pad <NUM>. The pad <NUM> may be adjustable with Velcro <NUM>. The pad <NUM> may attach to the mount <NUM>. As shown on <FIG>. An arm <NUM> may include a ratchet <NUM> for adjustment laterally. Vertical adjustment uses a handle <NUM>. The height and length may be adjusted as shown to allow desired positioning.

<FIG> shows upper supports <NUM> and a strap <NUM> coupling them together. The supports <NUM> include slits <NUM> to accept the strap <NUM> that connects it to the opposing side for cinching on the patient. A pad <NUM> may be disposed between the supports <NUM>. This allows for securing the patient. The straps may be tightened or loosened as desired.

<FIG> illustrate a bolster <NUM> that has translational movement so that it can accommodate varying patient anatomy and allow the user to push the bolster <NUM> into the patient's side after they've been positioned on the bed to create (or enhance) the coronal bend. <FIG> illustrates an initial position of the bolster <NUM>. The translational movement will have a locking feature <NUM> so that once it is placed in the desired position it will stay rigidly in place. The locking feature <NUM> may utilize ratcheting components or may use a "key" feature like a peg in hole, for example as described with regard to <FIG>. The locking feature <NUM> may include an arm <NUM>.

<FIG> illustrates translation of the bolster <NUM>. The translation feature may utilize a "crank" or "screw" where it moves forward as a handle is turned. The bolster <NUM> could be on a table arm mount where it can be moved on joints and locked into place. The bolster <NUM> is made out of primarily radiolucent materials so as not to disrupt x-ray imaging. The slider <NUM> portion may be contained within the track or be a separate removeable component. The slider <NUM> is reversible such that it can be introduced into the track <NUM> in either orientation. The reversible slider may have an offset pad support plate such that when introduced to the track <NUM> in different orientations, the reach of the pad is larger or smaller, accommodating patients of varying size.

<FIG> illustrates a contralateral bolster <NUM> that may have a multi-tooth lock <NUM> to allow the slider portion <NUM> to lock into position at any location within the slider track. The bolster <NUM> may be used to secure positioning of the patient. The multiple teeth <NUM> may be controlled by one unlocking button <NUM> such that the user can depress one button <NUM> to unlock either (or both) locking pawl teeth <NUM>. The bolster <NUM> may travel linearly.

<FIG> illustrate a ratcheting mechanism <NUM> for adjustment of the bolster <NUM>. The mechanism <NUM> may include teeth <NUM> and teeth <NUM> which are metal. The teeth <NUM> may extend along a moveable member <NUM>. The member <NUM> allows linear movement of the bolster <NUM>. The different rows of teeth may contact each other for adjustment. Other components may be plastic.

<FIG> shows a contralateral bolster <NUM> may also have a peg <NUM> to prevent the slider <NUM> from extending too far along the track, to a position in which no locking teeth are engaged with the ratcheting component of the slider <NUM>. The location of the peg <NUM> may also be indicated with an etched or otherwise marked line in the track to give the user visualization when the slider <NUM> is approaching or at particular location. Peg <NUM> may be used to lock the bolster <NUM> in place. The bolster <NUM> may include a frame <NUM> for attachment of a pad <NUM>. The frame <NUM> includes a lateral extension <NUM> with holes <NUM> for adjustment.

<FIG> illustrates the contralateral bolster <NUM>. The contralateral bolster <NUM> may include a removable depth adapter <NUM> that can be attached between the pad and pad plate in the event that the user needs additional throw. The adapter <NUM> may be a radiolucent material to reduce interference with x-ray imaging. Teeth <NUM> may extend along a moveable member <NUM> to allow linear movement. The member <NUM> may be movable disposed within a track <NUM>. The track <NUM> may be integrated into a frame <NUM>.

The described embodiments allow for control of tilt and padding break of a patient during surgery with a frame such as a Jackson frame.

Advantages may include padding break to improve lateral access in the prone position. Also, axial tilt is improved for lateral access when the patient is in the prone position. The axial tilt allows ATP access in the prone position. The padding break reduces scoliosis deformity from positioning. The asymmetric axial tilt reduces axial rotation deformity from positioning.

Claim 1:
A positioning system for positioning a body, the system comprising:
a pad (<NUM>)
an upper support (<NUM>) comprising:
a mounting plate (<NUM>) for the pad (<NUM>) configured to receive the body;
a hinge (<NUM>) comprising a curved surface including teeth (<NUM>), the curved surface operable to rotate;
a pawl (<NUM>) that is in contact with the teeth of the hinge (<NUM>), wherein the pawl (<NUM>) is operable to allow rotation of the pad (<NUM>) in a first direction due to angles of the teeth;
a moveable member (<NUM>) extending from the hinge (<NUM>), the moveable member (<NUM>) including teeth; and
a second pawl (<NUM>) that is in contact with the teeth of the moveable member (<NUM>), the second pawl (<NUM>) operable to allow movement of the moveable member (<NUM>) due to angles of the teeth of the moveable member (<NUM>); and
a lower support (<NUM>) connected to the upper support (<NUM>) via the moveable member (<NUM>).