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`EI4i'D7i'2E|11 EI5:EI4:U2 PM
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`This is Goog|e's cache of http:fi'\-wt-1-v.executivehm.comi’artic|ei’l\-'1|S--Navigation-|mproving-Spine-Suruerfl.
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`It is a snapshot ofthe page as it appeared on N1ar25,
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`_it"|‘I_;5QIf1y
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`MIS Sz Navigation: Improving Spine Surgery
`Medtronic | www-.medtronicna|iiga‘lion.com
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`
`rnost cfebiiitating pains a person can nave.
`
`Cnances are met you or someone you know nas been raid up with back pain, wnicn is certainiy one oftne
`
`|"nnfia-lnnmn in HI:nrIn'Iir +'mnr.u-
`
`People with back pain are oflen unable to do the things they need to do on a daily basis because the pain in
`their back and legs is just too severe forthem to go very-‘far orto maintain activity for prolonged periods.
`indeed, most patients with .
`l
`instabilityfind standing and walking most painful. Unfortunately’, an
`
`
`
`
`

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`
`Confidence in dynemicltimes
`.1 cl:-olc=H>>rl'.|1 Sr:|t.t.r."s
`'_v
`.-
`
`astounding number ofpeople live with these types ofsevere back and leg pain every day, and more than a
`million ofthem will have sufiiegithis year.
`
`Trends and Insights for healthcare
`Ieadersand physician executives
`
`
`
`Blog
`
`
`
`A New I-IR Strategy for a
`Better Company
`Getting an HR vision correct IS no easy
`task, but can be the difference maker...
`15 Mar 2011
`
`One surgeon who specializes in spine surgeries utilizing minimally invasive technigues (MIS) is Dr. Paul
`Holman ofthe Neurological Institute atthe Methodist Hospital in Houston. Dr Holman is among the growing
`population of surgeons promoting MIS, which is the term given to procedures thatfavor small muscle splitting
`incisinne tn annrnach the shine in nrrlertn avnirl mnre invasive trarlitinnal ellrgiral methnrls
`
`Atypical case treated with MIS involves decompression ora pinched nerve in the lumbar spine by a pair of
`venebrae that have become partially dislocated due to aging, degenerated ioints. Dr. Holman otten
`recommends a lumbar lamlnectomy to create more room forthe irritated nerve in combination with a
`technlgue called a ZTUSIDI1, which involves "weldlng"the two bones togetherto eliminate pain by
`excessive motion.
`
`MIS can oflen achieve the same goals as traditional, open surgeries, butwith less collateral damage to the
`patients normal anatomy. Since open surgeries regularly involve larger incisions, they naturallytake longerto
`heal. Since incisions can be smallerwith MIS, patients generally experience significantly less blood loss and
`morbidity, which can lead to shorter hospital stays and recoverytimes MIS patients are also less prone to
`
`symptoms ofprolonged pain and weakness rollowingf, emwhen compared with traditional, open surgical
`procedures. Additionally, lv1lEl patients run less rlskfrom transfusions and oibacterlal infection.
`
`MIS has provided advancements in many surgical fields, but spine surgeries lag behind, mostly due to a
`natural reluctance to change by surgeons Other resistance has come in the form of objections rising from a
`perceived limitert field nfvievv Rnme silrgennc: are rnncernert theywill lnee theirtyniral viccllr-ll rites rlllring MIR
`when compared with the anatomical landmarks open
`provides This concern is a valid apprehension
`for surgeons with limited experience with nI1|S.|n practice, however, the advancements in intra-operative
` and image-guided
`
`(lee), have virtually eliminated this issue.
`
`
`
`lGS has been used for more than a decade in many surgical circles, and especially in cranial applications for
`removal ofbrain tumors. IGS, in fact, will continue to promote the growth ofMlS because it allows surgeons to
`navigate to a target more accurately and safely. From a results perspective, surgeons need to put MIS on their
`radar. A surgeon's goal is to enable patients to get bacl-(to normal activities as soon as possible, and MIS has
`shown its success in achieving this objective time aflertime
`
`
`
`

`
`htt
`ffwebcache googleusercontent.comr’search?g=cache:OriD><Hm5cvLMJ:vvww executivehm. comr'artic|eflv1|S--Navigation-
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`rovinct-Spine-Surgeryf+spinal+surdery+usihd+imadinD1&cd=1D8.hl=en&ct=c|nk&g|=us&source=www.gootilecom
`EWDFIZEI11 EI5:EI4:U2 PM
`
`White Papers
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`V View all White Papers
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`MIS provides several clear advantages in a variety ofprocedures, notthe least ofwhich is pedicle screw
`placement in surgeries correcting deformities like scoliosis, surgeons are able to automatically register
`patient anatomy and immediately navigate in the spine
`proven tools that provide real-time CT-like
`
`images, such as the Medtronic O-ARiv1®
`System and StealthStation® Navigation System. Screw
`
`placement otten reguires millimeteraccuracy — a goal regularly achieved utilizing the advancedE
`provided by the O—ARM® and StealthStation® System Atter screws have been placed, surgeons can now look
`to the O—AFtiv1® System to checktheirworkwhile the patient is still in the OR — ratherthan waiting for a CTfrom
`radiology. The O-ARR-1® System allows surgeons to view intra-operative scans to verify that nerves have been
`thoroughly decompressed and pedicle screws have been accurately placed. By utilizing intra-operative
`E and navigation, surgeons may decrease the risk ofmal-placed instrumentation, and may reduce
`radiation exposure to patients and statT— all while enabling MIS technigues.
`
`Dr. Holman uses the O-ARlv1® in a number ofminimally invasive K procedures. Surgeons at the
`Methodist Hospital knewthat providing the best care rortheir patients would require advanced surgical
`technology, which is whythey lobbied to bring the O—AFtM® System to their OR. The Methodist Hospital was
`rourth in the countryto obtain the 0-ARME4 System and the nrst hospital in Texas to do so
`
`"With the O-AR’M®, we have the real-time advantage ofbeing able to scan anytime and update exactly where
`we are," Dr Holman commented '‘It's the ability ofthe 0-Al-'x'M®to take a picture and link itto this computerized
`system (tviedtronic Navigation System) so thatwhen you‘re inserting a screw or looking atthe spine, you can
`see exactly where you are in three dimensions. We remove pressure from the nerves, we put in the bone gratt,
`and the final step is typically inserting the screws thatwill immobilize the vertebrae. The typical patient that we
`can help is someone that has compression otthe nerve from a mechanical source —whetherthat's arthritic
`bone or a herniated disc that has pain going into the legs. That is the number one indication for any kind of
`
`To incorporate the 0-ARA-1® System into the OR, the system can be used in two ways. First, the system can be
`draned and remain in the surgical field throudhoutthe procedure orthe system can be used and then
`removed from the room The 0-ARMIB System has a custom drape that allows itto remain in the surgical field
`ifdesired, othentvise the patient is draped For an MIS procedure with Dr Holman, patient is prepped and the
`surgical field is made sterile. Next, the 0-ARM® System is brought in The 3-D images are acquired with
`automatic transferto the StealthStation® System navigation equipment, and the 0-ARM® System is removed
`from the OR. To verify accurate placement ofpedicle screws, the surgeon can bring the 0-ARiv1® System back
`into the room to perform a post-completion 3-D scan to ensure correct screw placement and other
`
`
`
`Don't let technology
`get in the way
`of your practice.
`ingenlx
`CareTra:lcer"" EHR;
`aftordabie---paced as
`Faster easier. and more
`low as $200 per prowder
`per month.
`A
`
`
`
`.
`.
`
`
`
`'
`
`\-“ g
`
`$3”-=
`
`=
`
`=
`
`.
`
`INEENIX.
`CareTracker"
`
` EXEREEN '
`
`Tempura lScanner"
`
`
`
`

`
`ffwebcache googleusercontent.comr’search?g=cache:OriD><Hm5cyLMJ:vv'wvv executivehm.comfartic|eflv1|S--Navigation-
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`lm roying-Spine-Surgeryf+spinal+surgery+using+imadinD1&cd=1D8.hl=en&ct=clnl<&d|=us&source=vvvyvv.gootilecom
`El-'1.-'D7.l'2El11 El5:El-'1:U2 PM
`
`verifications.
`
`Dr. Holman clearly values this feature highly.
`
`"The 0-ARtv1® System's ability to perform a pre-close spin to ensure accuracy is certainly a feature every
`surgeon needs in the OR Being able to know thatyou got it right the tirst time is a good feeling.''
`
`The O—ARM® System provides many advantages when used in conjunction with navigation. In addition to
`automatic registration, the 0-ARll-1® System acguires the 3-D data setwith the patient in the operative position,
`the reconstructed data is then automatically registered to the patient and readyfor When %
`tvledtronic I and Eliologics screws, surgeons can see a CAD model otthe screw on the navigation screen
`in the three planes: axial, coronal and sagittal. Additionally, the O-ARR-1® System may increase the number of
`minimally invasive procedures possible while potentially reducing patient and surgeon exposure to radiation
`
`The O-ARM® System by Medtronic delivers tomorrow's technology to the OR today in two ways. First, because
`it combines the bestfeatures ota C—arm with an intra—operative 3—D scanner, it provides an exceptional level of
`surgical unavailable until now. Second, the O-.lKl'\‘tv1® System works in tandem with the proven
`Medtronic StealthStation® System to enable seamless integration ofintraoperative
` with image
`guided's_L_i1‘g";1'”€§g
`
`Foryears, when people discussed intra-operativ
`theywere talking about C-arms With a
`
`conventional C-arm, there is no 360-degree spin capab
`ity, and therefore, the images available didn't provide
`surgeons with the best data to make treatment decisions. Additionally, surgeons have traditionally had to rely
`on 2-D IYTTSQES in me UH, WHICH QSVE tnem SCCQSS ID X-l'ay'\f|9WS,IJUIHDICT-IIKQlmagES.5|l'1C9 3 CT SCSH
`offers 360-degree acquisition capabilities, ratherthan flat, 2-D views, the CT view ensures surgeons are able
`to access a complete data set including axial, coronal and sagittal views unavailable with conventional
`fluoroscopy.
`
`The 0-Al-'s’M® System is similar in dimensions to a C-arm, but it has greater capabilities It allows surgeons to
`close the gantry and acquire images from 360-degrees oforbital rotation around the patient. The O-ARD/l®
`System has a similarfootprint to a C-arm, but it is structurally more robust, most notably because the simple
`geometry ofcirc|evs.thatofa''C‘'shape
`
`.. -4...» ..-...o..-..u,. .. A ........ u..- A nnum n....o,..... :,. II|l\:RdIll'\
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`
`
`

`
`ffwebcache googleusercontent.comr’search?q=cache:OriD><Hm5cvLMJ:vvvvvv executivehm.comfartic|eflv1|S--Navigation-
`htt
`lm rovinct-Spine-Surqeryf+spinal+surc1ery+usinc1+imaqinD1&cd=1D8.hl=en&ct=clnl<&q|=us&source=vvvvvv.dootllecom
`El-'1.-'D7.i'2El11 El5:El-'1:U2 PM
`
`in stark contrast to a C-arm, the 0-ARM® System is unique, and it represents a shift in the way surgeons look
`modalities. The O-AFllv1® System is the first mobile system that can make a
` at intra-operative .
`complete, 360-degree gantry spin, which provides exponentially more patient data than a C-arm allows. And of
`course, the more information obtained in a scan, the betterthe image quality. A prime example ofthis image
`quality lies in the 0-ARR-l® System's abilityto provide surgeons access to axial slices aflerthey acquire a 3-D
`scan, which enables surgeons to place screws in the exact spot and at the exact angle required —yet another
`feature the 0-Al-'s’M® System delivers that a standard C-arm cannot The 0-AFx’M® System delivers real-time 3-
`D data directly to the surgeon's hands.
`
`When a 3-D image is acquired, and the O-ARM® System is connected to the StealthStation®TREON®
`Elystem, where the Image Is tiansferred automatically and automatically iegisteied Atthe completion ofa 3-D
`acquisition, the 3-D data set as well as an AP and lateral image are sentto the StealthStation® TREON®
`System and automatically registered to the patient The speed to navigate is less than one minute from start of
`acquisition to registration ofimages on the StealthStation® System.
`
`The 0-ARM® System delivers a substantial savings in OR time. Its robotic repositioning saves manual time
`and increases
`accuracy. The system's ultra-high resolution contributes to exceptional image quality,
`which provides surgeons with more data — otten leading to improved accuracy and better outcomes. In
`addition, the system provides high X-ray power, a large field ofvievv, fast scan times, and both 2-D and 3-D
`capability.
`
`Advances in modern spine
`'_will continue to improve the quality oflite for a large number ofpatients,
`
`and the emergence ofminimally invasive spine surgical techniques are dramatically improving patients‘
`surgical experiences — allowing them to return to normal life activities more quickly And as intra-operative
` and navigation technologies continue to improve, minimally invasive surgeries will continue to
`become easierto perform. Employing these modern tools and technologies to complete MIS surgeries
`accurately and safely may lead to improved patient outcomes.
`
`More like this...
`
`The Healthcare Informer
`
`Driving Therapy Forward
`
`Future Shock
`
`
`
`

`
`ffwebcache googleusercontent.comi’search?q=cache:OriD><Hm5cyLMJ:w'ww executivehm.comfartic|efM|S--Navigation-
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`lm royiri£1-Spine-Surueryf+spinal+surc1ery+usinci+imac1inD1&ccl=1D8.hl=eri&ct=c|nl<&q|=us&source=\/uwiN.cloctilecom
`El-'1.-'D7.¢'2El11 El5:El-'l:U2 PM
`me J-ieaitncare J.I‘1IOt"IT1e1"
`
`President and CEO o1 The Henry J
`Kaiser Family Foundation, Dr Drew
`Altman, emphasizes the special role of
`the foundation as an independent,
`trusted source of information amid
`
`
`Patient—Reported
`Outcomes: the Better to
`Know Y...
`Chris Weiss is the Co-founder, President
`3 CEO of Dynamic Clinical Systems. The
`DCS secure Web-based solution.
`integrated Survey System® USS),
`enables patients to provide...
`
`D View all similar articles
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`LJr1v1ng J. nerapy r orwarci
`Gary Murray, Rohit Arora and Robert
`Elulgarelli take a look at ANS dysfunction
`and some ot the therapies available.
`
`
`t" uture ‘QIIOCK
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`The mission o1 M|T‘s MEHD Group is to
`envision the direction of the heaithcare
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`Put to the Test
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`United States. Screening has made an
`enormous difference to the mortality rate‘
`which now...
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`Practice Makes Perfect
`Improving patient care is central to the
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`http ffwebcache googleusercontent.comi’search?g=cache:dZ2ACfszce4J:wvvvv hea|thimaging.comi’index.php%3Foption%3Dc
`om articles%2Bview%3Dartic|e%2Bid%3D15t1El4+imatiinti+in+spinal+surgeries&cd=24&h|=en&ct=clnl-<&g|=us&source=wwvv.goo
`gle com
`El-'1.«'UBf2El11 11:13:21 AM
`
`This is Goog|e's cache of http:fi'\-vx-i-'i~v.hea|thimac1inEi.comi'inde><.php?option=com articles&view=.article3eid=15484 It is a snapshot ofthe page as it appeared on Mar
`28, 2011 DQ245227!‘ GMT. The current page could have changed in the meantime. Learn more
`
`These search terms are highlighted.fls'piti'a| These terms only appear in links pointing to this page. surgeries
`
`Text-onlyversion
`
` Health lmagingcom
`
`Type Keyword...
`
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`CLINICAL STUDIES
`
` Advanced
`technology bests fluoro as spinal surgery aid
`wmen b,,Edn°,,,,. gm;
`Using a 3D image-guided system to help place screws in the spines for §pln_al
`:'1\'°.'r'rihe’ff2,£’503
`fusion procedures results in safe and accurate surgery with a decrease in the
`pans,” E.MA||_ a
`number ofmisplaced screws and subsequent injuries, seen in more traditional
`operations, according to a study in the Dec 9 online edition ofthe Journal of
`FURTHER READING
`NEUFOSWQEW-' SPF”?-
`Person
`. Em Nmmeie,
`
`Physicians at the Mayo Clinic in Jacksonville, Fla , and colleagues reported that
`afier implanting 1DBr1 pedicle screws in 220 patients, surgeons found a nerve
`injury rate ofless than 1 percent.
`
`-9 neurosurgery "l lc-inn '3l|'1irnam:n,r~<iiir~lnr~ltnnlvinnlnnxrtn lvinln no nlcmn Hvinoci er-rnwo rnoiilto in ct
`
`Pmtals
`v Advanced Visualization
`
`section
`. ,;,,,,ica, 5,,,,1iE;
`Topic
`a spinal fusion
`
`Additionally, less than 1 percent ofthe screws in the study were considered to
`be significantly misplaced, compared to a reported nerve injury rate of up to B
`percent and a misplacement rate ofup to 55 percent using standard technology.
`As well, they reported a re-operation for removal ofa misplaced screw has been
`reported in other surgical literature to be as high as 5.5 percent but occurred in
`less than half of1 percent ofall patients, according to the researchers.
`
`watch video
`
`‘ '“““"' “'" """""
`
`'50"?-9“! 3'“! m°"9- 1
`
`
`
`

`
`http ffwebcache googleusercontent.comi’search?q=cache:dZ2ACtszce4J:vvww healthimagingcomfindex.php%3Foption%3Dc
`om articles%2Bview%3Dartic|e%2Bid%3D15t1El4+imat1inti+in+spinal+surderies&cd=24&h|=en&ct=cln|-<&d|=us&source=wvmN.doo
`gle com
`EWDBIZEI11 11:13:21 AM
`"Using 3D image-guided technology to help us place these screws results in a
`much better outcome for our patients," said Mayo Clinic neurosurgeon 1
`Nottmeier, MD, the study's lead investigator. ''In addition to the decreased
`incidence of nerve root injury, this technology allows us to place larger screws
`into the spine, which can also increase the success rate ofthe operation."
`
`I The technology uses a special camera on a computer that uses infrared light to
`
`M
`
`Radiology
`EXCellenCe
`Delivered.
`
`track a surgical instrument in 3D space, according to the researchers. The
`surgeon places the instrument on the patient's spine and navigates the spine
`using the computer The surgical instrument is used to determine the best entry
`point and trajectory for each screw. An image-guided screwdriver is used to
`place a screw.
`In most other institutions, pedicle screws are placed using a freehand technique
`__
`_
`or by fluoroscopy, which uses )<—rays to capture a 1D image on a television
`screen ofthe process of screw placement. Not only is the image less detailed, -.._ __-
`but both patients and the operating room eteficen be exposed to radiation and
`must use lead clothing for protection, Nottmeier said
`
`-
`Nbssl
`
`W
`
`He noted that almost all patients in this study were given a CT scan following
`surgery, so that a radiologist could independently determine how well the screws
`were placed.
`
`"Tl’llS IQCl’ll'1lqLlQ allows LIS ID have ll’lQ DESI VlQW pDSSllJlQ ofthe VQYIQDTSQ 33 we
`operate," Nottmeier said.
`...:
`,
`
`
`
`Tcclumlngy
`
`lnnovatlon ' Confidence . Llfe
`
`
`
`

`
`http ffwebcache googfleusercontent.comfsearch?q=cache:dZ2ACfszce4J:vwwv hea|thimaging.comf1ndex.php%3Foption%3Dc
`om articles%2Bview%3Dar1ic|e%2Bid%3D15t1Ei4+imat1inE1+in-+353ina|+surc1eries&cd=24&h|=en&c1=c|n|-<&c1|=us&source=\-wwv.£100
`gle com
`EWDBIZEI11 11:13:21 AM
`
`performing
`AFEs for
`
`supeflor
`ultrasound
`- CW made for blood
`flow velorzihj
`0 Best power-"noJ5e
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`» Order Earn
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`1 PH
`
`tuinut Ll-,=.|
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`II.1::r:t31::t Ll-,=.| ln1idi.a L-=.it