An O-arm advantage

Technology first of its kind in state, aids in first CPH spine surgery

For months, Quinton Walker's right foot was numb and his knee on the same leg would sometimes buckle under pain.
The 47-year-old Soldotna resident and school janitor previously had spine surgery to help correct his chronic back problems, but he said that surgeon didn't get it quite right.
"My titanium rod was bent and pinching on my nerve," Walker said Friday, resting in his bed at Central Peninsula Hospital.
On Wednesday, however, Walker went under the knife of Dr. Craig Humphreys and was wiggling his toes in his bed a few days later, remarking at his expanded range of motion.
Walker said he knew Humphreys fixed the problem, but was unaware his spine surgery was the first in CPH's history and used a ground-breaking piece of technology - the only one of its kind in the state, staff said.
That technology came in the form of the Medtronic O-arm Surgical Imaging System. The doughnut-shaped O-arm is as heavy as it is expensive and rare, Humphreys said. It allows for multi-dimensional surgical imaging mostly for use in spine surgeries and real-time, intra-operative imaging of a patient's anatomy.
Essentially, a section of the patient is scanned by the O-arm and then the surgeon can use and manipulate a 3D image of the patient's spine projected on a screen to more accurately perform the operation. The system also provides three, 2D cross-sections, for a different view.
"The other thing is there is a real learning curve for the surgeon - you get to see anatomy you put things in and you get to see it in three dimensions," he said. "So the feedback from a surgeon's point of view is that it allows you to get a better three dimensional idea of what is going on with the patients. After seeing patients that way, when you get it, your mind clicks into that 3D as opposed to if you have never used it and you are used to looking at single shots."
The whole system is synced in real time, projecting images of the surgery as it happens, offering the surgeon a highly technological perspective.
"It is particularly important when you are doing minimally invasive surgery, when you are trying to keep the incision real small so you can see exactly where you are as you clean up," Humphreys said. "It is really important in the case like we had Wednesday because he had prior surgery by somebody else and the anatomy is goofy."
Using the O-arm has numerous advantages, including less invasive and more accurate surgeries that are safer for staff, more intuitive for doctors and reduce infection rates and patient recovery time from a hospital stay of weeks to days, he said.
The O-arm system is rare because of its cost - close to $1.5 million - size, and the amount of training and know-how required to effectively use it. Humphreys, however, has the training from his prior practice in Chattanooga, Tenn., where he operated with two O-arms. Humphreys also recently opened his private practice, Kenai Spine, co-located with Kenai Peninsula Orthopedics in Soldotna.
Just a few years ago, he said the O-arm technology wasn't as accurate as it is today. But, despite the advances, the technology doesn't replace a good pair of steady hands, he said.
"You've still got to be smarter than the robot or at least understand what the robot is doing," he said.
The rub at CPH was getting everything set up and staff trained to perform the first spine surgery.
"It is not something that someone just sets up in your hospital and you jump into it," he said. "You have to learn and the staff is miserable at first because it is hard to move and it is something they are not used to."
Getting the O-arm to CPH was a more than three-year endeavor, he said.
"I think the significance of it was that there is just a ton of logistics," Humphreys said. "I mean, I have done 6,000 to 7,000 spine surgeries and I do a lot of revision spine surgeries was a difficult case, but it wasn't anything outside of what we do."
Although Wednesday's surgery was anything but unusual for Humphreys, CPH Chief Executive Officer Ryan Smith said it was an achievement for the hospital.
"There will be patients that are attracted to Dr. Humphreys and the technology here from around the state," he said. "If you want to have a spine surgery with the latest technology then we have that in the state of Alaska now."
Smith started recruiting Humphreys - who grew up in Anchorage - to the area from Tennessee after a chance encounter several years ago.
"If you are going to do spine surgery in Soldotna, it has to be as good as anywhere else," Humphreys said. "I said I would be willing to come back and try it, but there is a commitment that I didn't think they really understood.
"Ryan said, ‘Well, tell us what you need,' and I did really never expecting to hear from them again and they came through. They knew what I wanted."
The less-than-hasty decision to bring spine surgery to CPH took a little bit of marketing analysis, Smith said.
"He took a chance and I took a chance," Humphreys said. "I think it was a very educated chance. We did the demographics and we looked at everything."
According to data collected by CPH, more than 200 residents in the hospital's service area go elsewhere for spine surgeries. That doesn't include those who leave the state for surgeries, he added.
Smith said although spine surgery wasn't specifically identified in the hospital's strategic plan, it fit with CPH's goal of providing services so residents didn't need to travel for care.
Both Smith and Humphreys think the O-arm and Wednesday's surgery is more than just a pair of firsts - they represent the future of the hospital.
"It is kind of like a ‘Field of Dreams' kind of a thing - if you build it, they will come - but really this is really good technology that you really wouldn't expect at a hospital this size," Humphreys said.
For now, Humphreys has a fan in Walker, who said it would be nice to be back on his feet in a few days and back to work in a month or so.
"I'm glad we have a doctor down here now on the Peninsula," he said. "I'd recommend him."