DePuy Synthes Slashes OR Radiation With New MIS Navigation

Intraoperative CT navigation is the key to MIS spine surgery. But the price paid in terms of radiation exposure to the patient and the cumulative wear and tear on the OR team from wearing lead aprons is high.

So, when we saw DePuy Synthes’ new KICK system at the 2016 annual meeting of the North American Spine Society (NASS), we had to highlight it in OTW.

KICK is a clear departure from the main stream intraoperative CT navigation systems which are costly, used for high-end surgical procedures and, perhaps most significantly, entail radiation exposure for the patient, hours and hours of wearing lead aprons and are usually only found in larger hospital systems or academic centers.

KICK is the brainchild of a DePuy Synthes and BrainLAB partnership. It is a portable, cost-effective 2D image guidance system which allows surgeons to perform minimally invasive lumbar spine procedures under navigation, while minimizing the need for static X-ray images.

DePuy Synthes showcased the KICK system with the FluoroExpress Software Module at the annual meeting of the North American Spine Society and a handful of hospitals are testing it before its official launch in January. KICK is compatible with the VIPER System and the EXPEDIUM Spine System of implants and can be used for a broad range of spinal disorders.

“The KICK System enhances less invasive surgery for the clinician, who may not have access to expensive 3D imaging systems, but recognizes the need for advanced imaging to support a successful fusion procedure and help improve patient outcomes, ” said Dan Wildman, Platform Leader, DePuy Synthes Spine.

System Operates Like GPS for the Body

The KICK image-guided surgery technology enables real-time intraoperative viewing of instrumentation and implants relative to patient anatomy to assist in pedicle screw placement. Using a small, portable infrared camera with a computer and monitor, the system moves easily between operating rooms and works together with existing X-ray equipment to support surgical workflow.

The KICK computer can connect with the MRI, C-ARM (X-ray) or other imaging device that takes intraoperative pictures of the patient’s back. KICK then links up with the instruments the surgeon uses during surgery. It tracks where the surgeon is using the surgical instruments, and overlays their position on the interoperative image taken by the C-ARM..

Tracking is done using three spheres, like small jaw-breaker candies, that are attached to the tops of each surgical instrument (screwdiver, tap, etc.). The camera tracks the spheres through infrared signal and then calculates the physical location of the instrument with respect to the patient’s anatomy

“The spheres reflect infrared light, ” said Adam LaWare, group product director, North America Spine Marketing, DePuy Synthes. “There’s a monitor which displays the image and there’s a camera, which reflects off the spheres. The spheres reflect infrared light back to the camera, so it can sense where the spheres are in space. The system correlates the sphere pattern with the particular instruments, and displays those instruments on the screen, rather than just the sphere pattern.”

System Could Reduce Long-Term Radiation Exposure

KICK could help reduce long-term radiation exposure and reduces operating time for surgeons who use fluoroscopic imaging. “With KICK, a surgeon can import fluoroscopic images and calibrate surgical instruments to the image guidance system, ” said LaWare. The monitor displays up to four different X-ray images at one time to help reduce the time it takes to reposition the x-ray equipment repeatedly throughout the surgical case.

“As neurosurgeons are becoming more involved with spinal care and with a younger generation of surgeons moving into treating spine cases, we’re seeing increased interest in analyzing the amount of radiation a spine surgeon can be exposed to over the course of their career, ” said LaWare.

Research literature and current health concerns of some of the forefathers of spine surgery supports the need for more analysis, LaWare said. “Surgeons are coming to us asking for solutions that would reduce the amount of radiation exposure that they are exposed to, so we are starting to see across the market some pretty interesting technologies that are coming out with the sole value proposition of reducing overall radiation exposure.

“KICK may be a great solution that may be able to help, ” said LaWare. “Without KICK, a surgeon relies on continuous 2D fluoroscopy to assess every step of the procedure, ” said LaWare. “With KICK, radiation exposure over the course of a procedure may decrease, and if you extrapolate that over the course of a surgeon’s career, it could have a pretty impactful, cumulative effect.”

Expanding Access to Enhanced Visualization Systems

Per the October 26, 2016 press release: “Research has shown that only 11% of spine surgeons in North America and Europe use advanced imaging technologies, even though image-guided spine surgery helps achieve accurate screw insertion and reduces the likelihood of revision surgery to adjust screw placement. DePuy Synthes Spine, Part of the Johnson & Johnson Family of Companies, has partnered with navigation leader Brainlab to expand access to advanced visualization through the KICK System.”

“In recognition of the need to broaden access to image-guided surgery in spine, the AO Foundation’s technical commission (AOTK) approved the use of the KICK System in AO education courses. The KICK System is the first advanced visualization technology in spine to be approved by the AO Foundation, providing an opportunity for more surgeons around the world to be trained on image-guided surgery.”