Have a lumbar sciatica? You want the O-Arm

By GREGORY ZELLER //

The first Long Island spinal surgeries incorporating a state-of-the-art “intraoperative surgical imaging system” have been successfully completed, with many more to come.

In early March, Robert Kerr, chief of neurosurgery at Northwell Health’s Huntington Hospital, performed a lumbar sciatica procedure on a 48-year-old Northport resident using the O-Arm, a real-time 3D-imaging system produced by Irish medical-tech giant Medtronic.

About a week later, Kerr performed a lateral mass screw and rod fixation using the O-Arm, which performs a 20-second scan sequence that transmits a three-dimensional computer model of the spine to operating-room monitors, giving surgeons real-time positioning of surgical tools and implants with sub-millimeter accuracy.

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Dr. Robert Kerr

Both procedures went well, according to the neurosurgeon, as did a subsequent operation in which another Huntington Hospital orthopedic team used the O-Arm during a tricky spinal fusion.

The positive results didn’t surprise Kerr, who’s used the O-Arm before. Medtronic, which maintains its U.S. headquarters in Minnesota, began rolling out the technology about seven years ago, and Kerr – a Canadian national recruited by then-North Shore-LIJ in 2014 – first tested it while working at The Iowa Clinic.

The device made an impression, Kerr said, not only for its hyper-accurate imaging but for the relatively low doses of radiation it delivers when producing those internal images. With increasing concerns in healthcare circles regarding X-ray doses delivered to patients, practitioners are placing a premium on low-dose scanning technologies – though achieving high-quality imaging at reduced radiation levels has proven challenging.

Medtronic’s O-Arm uses a 30-by-40 centimeter, 3 megapixel flat-panel detector to create 2D and 3D images in a fraction of the time it takes 2D fluoroscopy and other traditional imaging technologies to perform. That’s a quantum leap in patient safety and no small benefit to surgical teams, Kerr noted.

“A traditional fluoroscopic X-ray unit in the operating room requires all members of the surgical team to wear lead,” the neurosurgeon said, adding those aprons are “heavy and sweaty.”

“And radiation from intermittent X-rays really adds up over a course of hours,” he noted. “The O-Arm, which takes a scan in 15 to 20 seconds, is a really important asset in terms of safety, for both the patient and the operating teams.”

When North Shore-LIJ brought on Kerr about two years ago and tasked him with “bringing neurosurgery to the forefront,” as he termed it, he knew which way to go.

“I reviewed other technologies, but I felt the O-Arm was the best,” Kerr told Innovate LI. “It really does represent the safest and most efficient way to perform high-end, complex spinal instrumentation and fusion.”

And when it comes to complex spinal instrumentation, he added, the more accurate, the better.

“When you have to place a stabilizing screw into the spine and it passes within millimeters of the spinal cord, nerve root or vital arteries, there is no substitute for the kind of accuracy the O-arm provides to a neurosurgeon,” Kerr noted. “And every patient is completely different, no matter how similar things may seem from human being to human being, especially when there’s trauma.

“It’s the difference between flying a plane by looking out the window and following the roads far below, or using radar and GPS,” he added. “Things tend to work out better with a higher degree of precision.”

Another crucial benefit: Surgeons can get an unprecedented look at the results of a procedure right there in the operating room, and if something is a millimeter off, they can go right back in without waking the patient – dramatically reducing the need for subsequent surgeries.

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Kerr with the first Long Island O-Arm patient.

In the case of the Northport patient, MRI scans revealed a severe degenerative disc disease and spondylosis, a painful spinal condition requiring decompression and spinal-fusion surgery. Kerr called in the O-Arm, and according to the hospital, the patient was up and walking the day after the procedure, without the back pain that had hounded her for years.

The O-Arm’s Long Island debut was slightly delayed while the future Northwell Health system prioritized the acquisition of other surgical technologies, including the da Vinci Surgical System, a minimally invasive imaging/operating system with benefits for cardiac, thoracic and a host of other procedures.

But now that the O-Arm has proven itself in multiple Huntington Hospital procedures, Northwell Health surgeons are lining up. Kerr has several additional procedures scheduled, and the benefits of Medtronic’s state-of-the-art system might not be limited to spinal operations.

A Northwell Health pediatric spine specialist is “keenly interested” in landing an O-Arm unit for Cohen’s Children’s Hospital in New Hyde Park, according to Kerr, who said the device has many potential applications – including imaging and operational advantages during complex orthopedic joint replacements and procedures related to fractures.

“Orthopedic surgeons are already using this for complex fractures, not to navigate surgical instrumentation but to do post-surgical 3D scans before they leave the operating room to make sure the alignment is ideal.” Kerr noted.

The O-Arm units are “big and heavy,” the neurosurgeon added, and while they can be wheeled from room to room, transporting them from facility to facility is not an option. That means whatever hospital is going to incorporate the technology needs an O-Arm of its own – and Kerr said he expects more hospitals, including additional facilities within the Northwell Health system, to bring them in.

“With this degree of accuracy, we can move much more readily and ply minimally invasive technologies with a broader hand,” he said. “We can determine the perfect size and placement of a screw, for instance, and we can even determine the perfect trajectory to avoid the muscle dissection and ligament disruption that a traditional surgery requires, allowing the patients to recover better.

“There’s greater vision, higher accuracy and a higher degree of safety for the surgical team and the patients,” Kerr added. “There’s a lot to be pleased about.”

 


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