Effect of an Adjustable Hinged Carbon Fiber Operating Table on Sagittal Alignment of the Lumbar Spine

Round 1

Reviewer 1 Report

The paper presents a quantitative analysis of the lumbar lordosis variation in 3 positional variations of a hinged operating table.

The study appears simple and well described.

The limits are shown.

Ethics committee approval is reported.

 

I only suggest some improvements:

1. Page 2 line 52: "However, there is no quantitative study to evaluate table bending effect for lumbar lordosis." Are you sure you can say this? There is also an article you reported in the references (Sebastian AS, et al. Effect of an Adjustable Hinged Operating Table on Lumbar Lordosis During Lumbar Surgery. Spine (Phila Pa 1976). 2018 Feb) which seems to conduct this type of analysis. Please clarify this point.

 

2. Specify the software used to calculate the degrees of lordosis.

 

3. In table 3 correct "Lumbur" with Lumbar and "flextion" with Flexion.

Author Response

We appreciate your important contribution.

1. Page 2 line 52: "However, there is no quantitative study to evaluate table bending effect for lumbar lordosis." Are you sure you can say this? There is also an article you reported in the references (Sebastian AS, et al. Effect of an Adjustable Hinged Operating Table on Lumbar Lordosis During Lumbar Surgery. Spine (Phila Pa 1976). 2018 Feb) which seems to conduct this type of analysis. Please clarify this point.

We appreciate your important comment. We change the sentence as follows;

there is only one quantitative study to evaluate table bending effect for lumbar lordosis [5].

2. Specify the software used to calculate the degrees of lordosis.

We measure the angle with Clinical Intelligence Technology & Architecture (CITA) (Fujifilm corporation, Tokyo, Japan).

3. In table 3 correct "Lumbur" with Lumbar and "flextion" with Flexion.

Thank you for your comment. We corrected the typos.

Author Response File: Author Response.pdf

Reviewer 2 Report

A very well structured and well written study. I strongly recommend the publication of the study!

Author Response

Thank you for your wonderful comment.

Author Response File: Author Response.pdf

Reviewer 3 Report

The authors describe the changes in lumbar alignment by using a Mizuho table in 33 patients.

We use a similar operating table (with additional side bolsters when necessary) and the bottom line is that we adjust the table until we achieve the desired position of the patient. I see no benefit in knowing what the table "efficacy" may be, nor the degree of lumbar lordosis achieved in the various table positions. 

Author Response

We appreciate your important contribution.

The authors describe the changes in lumbar alignment by using a Mizuho table in 33 patients.

We use a similar operating table (with additional side bolsters when necessary) and the bottom line is that we adjust the table until we achieve the desired position of the patient. I see no benefit in knowing what the table "efficacy" may be, nor the degree of lumbar lordosis achieved in the various table positions. 

We appreciate your important and severe comment.

When we’d like to perform lumbar discectomy, we’ll bend the table in convex way. On the other hand, when performing interbody fusion such as PLIF or TLIF, we’d like to make a good lumbar lordosis to prevent adjacent segment disease. Without this kind of Adjustable Hinged Carbon Fiber Operating Table, it is a little difficult to change the patient position from flexion to extension. Even though we bend 20 degrees table concave bending, we are not so sure about how much lordosis we can create with the table. With our results, 20 degrees concave bending may be able to create additional 6.8 degrees lumbar lordosis.

 

Author Response File: Author Response.pdf

Reviewer 4 Report

This is a routine study. The authors concluded that alignment of the lumbar spine is critical for performing spinal surgery and that spinal deformity surgery requires the creation of sufficient lumbar anterior convexity to obtain excellent surgical results. To achieve these goals, the table bending angle should be reduced or increased during compression and instrumentation, respectively. The Adjustable Hinged Carbon Fiber Operating Table (AHCFOT) is widely used to achieve this goal. The table allows the surgeon to manipulate the lumbar curve during prone spine surgery Tan demonstrates the effect of various tables and patient positioning to make changes in lumbar anterior convexity during surgery . The AHCFOT allows the surgeon to manipulate lumbar lordosis during spine surgery by providing a specific degree of flexion mechanism via remote control. the AHCFOT allows for an arc of motion from flexion to extension at the lumbar curve without The AHCFOT allows for an arc of motion from flexion to extension in lumbar flexion without affecting the overall lumbar lordosis beyond the physiological level . Lumbar alignment in the sagittal and coronal planes is of primary importance, and the effect of surgical correction on physiologic factors cannot be overemphasized. The authors reported a quantitative study of the effect of lateral table bending in lateral recumbent patients . However, there are no quantitative studies to assess the bending effects of lumbar kyphosis. The focus of this study was to observe significant changes in lumbar 53 kyphosis in 3 key positional changes of the hinged surgical table. The manuscript reflects much of the work, and the clinical implications have well worth continuing to explore further.

 

 General comments.

 

1. Fewer clinical cases.

 

2. No consideration was given to whether the tool could be applied to all cases.

 

3. Less data available.

 

 Other comments.

 

1. the quality of the figures is too difficult to read.

 

2. There are many grammatical errors in the manuscript. English should be edited.

 

 

Author Response

We appreciate your important contribution.

 

We appreciate your important contribution.

 General comments.

1. Fewer clinical cases.

We appreciate your valuable comment. We already mentioned this limitation in discussion part.

2. No consideration was given to whether the tool could be applied to all cases.

Thank you for your comment. No tool was applied to all cases.

3. Less data available.

We appreciate your comment. We’d like to make this study so simple.

 Other comments.

1. the quality of the figures is too difficult to read.

Thank you for your important comment. Because of the patient safety, we usually use the low dose radiogram. And due to this special operating table, the quality of the figures was not so clear. We measure the angle with Clinical Intelligence Technology & Architecture (CITA) (Fujifilm corporation, Tokyo, Japan).

2. There are many grammatical errors in the manuscript. English should be edited.

 We corrected grammatical errors as you mentioned.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

I have no new comments.

Author Response

Dear respective reviewer,

Thank you for your comment.

We appreciate your important effort.

Best regards,

Author Response File: Author Response.docx

Reviewer 4 Report

This is a routine study. The authors concluded that alignment of the lumbar spine is critical for performing spinal surgery and that spinal deformity surgery requires the creation of sufficient lumbar anterior convexity to obtain excellent surgical results. To achieve these goals, the table bending angle should be reduced or increased during compression and instrumentation, respectively. The Adjustable Hinged Carbon Fiber Operating Table (AHCFOT) is widely used to achieve this goal. The table allows the surgeon to manipulate the lumbar curve during prone spine surgery Tan demonstrates the effect of various tables and patient positioning to make changes in lumbar anterior convexity during surgery . The AHCFOT allows the surgeon to manipulate lumbar lordosis during spine surgery by providing a specific degree of flexion mechanism via remote control. the AHCFOT allows for an arc of motion from flexion to extension at the lumbar curve without The AHCFOT allows for an arc of motion from flexion to extension in lumbar flexion without affecting the overall lumbar lordosis beyond the physiological level . Lumbar alignment in the sagittal and coronal planes is of primary importance, and the effect of surgical correction on physiologic factors cannot be overemphasized. The authors reported a quantitative study of the effect of lateral table bending in lateral recumbent patients . However, there are no quantitative studies to assess the bending effects of lumbar kyphosis. The focus of this study was to observe significant changes in lumbar 53 kyphosis in 3 key positional changes of the hinged surgical table. The manuscript reflects much of the work, and the clinical implications have well worth continuing to explore further.

It is suggested that some basic experiments can be added, and if there are problems with the molding, can some basic experiments be added by obtaining clinical cases to enhance the persuasiveness of the article

Author Response

Dear respective reviewer,

We appreciate your important comments.

It is suggested that some basic experiments can be added, and if there are problems with the molding, can some basic experiments be added by obtaining clinical cases to enhance the persuasiveness of the article.

We added two clinical cases according to your advice.

Case presentation

Case 1 75 years old man, L4 degenerative spondylolisthesis

Figure 5. 75 years old man, L4 degenerative spondylolisthesis, L4/5 oblique lumbar interbody fusion. A: Preoperative anteroposterior radiogram, B: Preoperative lateral radiogram (L4-5 local lordosis 8 degrees), C: Postoperative anteroposterior radiogram, D: Postoperative anteroposterior radiogram (L4-5 local lordosis 19 degrees).

Case 2 72 years old woman, adult spinal deformity

Figure 5. 72 years old woman, adult spinal deformity, T10-pelvis fixation. A: Preoperative anteroposterior radiogram, B: Preoperative lateral radiogram (sagittal vertical axis 83mm, lumbar lordosis 7 degrees, pelvic tilt 39 degrees), C: Preoperative CT, D: Postoperative anteroposterior radiogram, E: Postoperative anteroposterior radiogram (sagittal vertical axis 0mm, lumbar lordosis 46 degrees, pelvic tilt 24 degrees), F:Postoperative CT.

 

 

Author Response File: Author Response.docx