Jonathan Duncan, MD, an Orthopeadic Spine Surgeon at San Antonio Orthopaedic Group and Baptist Health System talks about the O-arm and how it improves quality.
Interview conducted by Ivanhoe Broadcast News in December 2018.
The newer O-arm that you have compared to the one that you’ve been using, how is this an improvement over that technology?
Dr. Duncan: Well, the O-arm in general is a better technology than previous imaging technologies that we have. In that, it gives us a clearer picture, it’s mobile so multiple surgeons can use it at the same time, the same day. A patient doesn’t have to move, it gives us CT like quality pictures instead of just plain x-ray.
The difference between the 2-D and the 3-D that you showed us, night and day really.
Dr. Duncan: It’s pretty amazing, pretty amazing and when we’re in the operating room and we’re doing the case we can use. What was the question?
When we were in the operating room.
Dr. Duncan: When we’re in the operating room, we can use live navigation. There are trackers on the patient, I can put a probe or any sort of instrument inside the patient next to the spinal cord, and it tells me on the screen and in live real time where I am. And that allows us to safely place instruments around the spinal cord.
So this is a combination of GPS navigational technique and the 3-D pulled in together?
Dr. Duncan: Correct.
How do those work together?
Dr. Duncan: That’s a good question for the engineers I don’t know.
As a doctor though you’re seeing, you’re tracking what you put in there and then you’re seeing the actual, it’s like you’re looking down in to somebody’s spine.
Dr. Duncan: Yeah, yes. It also allows us to do more minimally invasive cases. There are times when we can do this without making a big incision. We can make a small little incision and we can put instruments or different tools to do the surgery without having to open the entire spine up.
As a physician who has operated without this before how does it feel different to you in terms of your confidence that you’re in exactly the right place, the patient’s outcome, all of that?
Dr. Duncan: It’s a fantastic tool, and often times if we have a concern at the end of the case we can go and do a scan at the end of the case. It’s like getting a CT scan while we’re still in the operating room. So that if anything is out of place we can fix it immediately instead of finding out days later and having to bring the patient back for a second surgery. It’s really a patient safety tool as well.
Conceivably it could prevent
Dr. Duncan: Conceivably it could
The 2-D and the 3-D as well.
Dr. Duncan: I thought you were getting at preventing something.
Preventing excess surgery.
Dr. Duncan: Yes, so it can also be a tool to hopefully prevent, you know, unnecessary surgeries or repeat surgeries or revision surgeries because of misplaced screws or other sort of spinal instruments.
So the patient that we’re going to see how has this helped out with her specifically?
Dr. Duncan: So specifically with her she had a lot of abnormal anatomy from previous surgeries.
Specifically with the patient we’re going to see.
Dr. Duncan: Oh her case, yeah. In her case, she had multiple previous surgeries; her anatomy was not normal because of the surgeries and from the sever degeneration she had in her spine and the scoliosis the deformity. We learn in anatomy what’s normal in medical school, but a lot of times the patient’s anatomy is not normal at all. And so it helps us you know better picture their actual specific anatomy for that patient. And in her case it helps us both place the hardware that we needed to stabilize her spine but also to check and confirm before we left that everything was perfectly placed.
I think now days back surgery is more prevalent, people are sitting longer it’s distorting their spine. Something like this how much better is this that the technology is almost surpassing the injury?
Dr. Duncan: Well you know their medicine is often late to the game in technology. They’ve had these technologies for many decades and so bringing it to the operating room is a step obviously that’s difficult because everything we do is about patient safety. And we have to make sure it’s safe first. But now that we’re using it, it’s again another tool that a surgeon can use to help our patient.
And in terms of safety is this any safer than a regular x-ray?
Dr. Duncan: It is a little more radiation than a single x-ray, but often times when using x-ray machines in the operating room, surgeons have to use multiple shots over the course of the case. And if you add up the cumulative dose oftentimes, one spin from the O-arm is actually less radiation. And it’s certainly less radiation for the rest of the team because they can leave the room while it’s spinning and then there’s no more radiation for the rest of the case.
So in the middle of the procedure for the presentation as you were kind of taking and checking her and seeing what was happening what were you seeing specifically? What were you looking for?
Dr. Duncan: We were looking for specific abnormalities of her anatomy so that we could prevent you know neurologic injury. Prevent injury to the spinal cord or the nerves.
What were you seeing, were you seeing like the actual screws?
Dr. Duncan: That’s part of it, yes. Part of it is we see the screws, but we can also see the bones spurs that are there, we can see the collapsed discs we can see the disc space. So really, everything that you would see on a normal CT scan you can see live.
And the last question is and I sort of made an assumption an increase in back surgery because of sitting, are you really seeing that more prevent with older adults?
Dr. Duncan: Well we have seen they wait until I start talking.
In older adults from sitting?
Dr. Duncan: We have better tools than we used to. For sclerosis, decades ago, we had to treat people in a body cast, and now we have better tools to treat those sort of spinal deformities, and as we do that we can have great patient outcomes for very complicated cases that previously we weren’t able to do at all or had a lot of difficulty with recovery because of the lack of technology.
As a surgeon and physician how exciting is this new technology for you?
Dr. Duncan: It keeps us motivated, it keeps us interested. Surgeons were always looking to make things better. We’re never content with the way things are. We’re continually trying to push the envelope. We like new technology but we have to be careful you know that we’re always thinking of the patient first. Safety first so that’s the key.
END OF INTERVIEW
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