Two patients came in the same month. Both needed discectomies. Both had BMIs over 40. The plan was straightforward… until we realized they exceeded the weight limit on our standard prone positioning frame.

The solution was already in the hospital. A surgical table in the back corner of the OR: an open prone frame with a mechanical flexion/extension hinge and a degree readout on the remote. No one had mentioned it during orientation. No mentor had brought it up in training. It had been sitting there, unused, while the spine surgeons before me walked past it. It worked beautifully for those two endoscopic discectomies and I’ve used it for all decompressions since. Flexing the bed splays the posterior elements and opens the working corridor.

And it’s been just as useful for long-segment fusions! Once the screws are placed and decompression is done, I ask anesthesia to grab the remote: “Extend to 5 degrees.” I watch my decompression sites as the table adjusts slowly. “Take it to 10.”

One table. Both ends of what I do: the least invasive and the most complex. Nobody taught me this. The table was there the whole time.

(Illustration generated with AI.)