Circle Back

How a new surgeon and new technology are advancing spine surgery at Mary Greeley.

By Steve Sullivan

A dark, hollowed-out space around the screw tells a painful, frustrating story.

The screw is intended to fuse vertebrae on the spine of a man who has had five back surgeries but is still experiencing pain. The shadow surrounding the screw, clearly visible on an X-ray, indicates that the small shaft of metal isn’t doing its job.

The man is soon going to have his sixth back surgery, and this time it’s going to be different. He will be operated on by Dr. Jonathan Geisinger, a new spine surgeon with McFarland Clinic, who will use an advanced piece of equipment called the O-Arm. The O-arm is the latest high-tech device that Mary Greeley has added to its surgical toolbox.


Imagine driving through downtown Chicago guided only by your memory of previous visits to the city. You’ll get to where you are going eventually but might be surprised along the way by detours caused by construction or accidents. Now imagine doing it with an advanced GPS that will help you navigate with real-time notifications of route conditions.

The O-arm works in a similar fashion, providing a more precise map of an individual’s spine during surgery.

“It is really great in revision circumstances, which means a previous surgery needs to be corrected,” Geisinger said. “It’s great for when your anatomy is altered or different. You can do these surgeries using your anatomy knowledge, using landmarks, but the O-arm adds another layer of accuracy. It allows you to put instruments in highly accurate places and helps you to place them more precisely. A more reliable surgery means a better outcome.”

Advancing Spine Surgery: A look at the O-Arm at Mary Greeley

Learn more about the O-Arm and how Dr. Geisinger uses it for spine surgery in the video below.


The O-arm system provides real-time, intraoperative imaging of a patient’s anatomy with high-quality images and a large field-of-view in both two and three dimensions.

The images provided by the O-arm are transferred to a StealthStation Navigation System, which creates a 3-D map of a patient’s anatomy using the O-arm’s imaging data. Geisinger and his surgical team can view the StealthStation screen as he works on the patient’s spine or neck. The system enables Geisinger to choose the best size of screw to fuse vertebrae, and to precisely navigate the placement of the screw.


After Geisinger opens the surgical area on the patient’s back, he attaches a multipronged device called a “reference frame” to the patient’s spine. The frame is sort of an intermediary, facilitating communication between the O-arm Imaging System and the StealthStation Navigation System during the spinal procedure. It must remain stable during the surgery, or the process must start all over again.

The O-arm is then brought in, literally encircling the patient on the operating table. After it is in place, it is activated, “spinning” around the patient and recording those real-time 3-D images of the patient’s anatomy at the surgical site.

“Everyone’s anatomy is different, and this system allows you to place the biggest screw possible for each patient,” said Geisinger. “Bigger screws contribute to a more reliable fusion.”

A Fan

Geisinger grew up on a farm in northwest Iowa and has had Ames and McFarland Clinic on his radar for several years. He had been practicing in Sioux Falls, South Dakota, when the opportunity to join the clinic opened.

His one request: get an O-arm for Mary Greeley’s operating room. Geisinger was introduced to the O-arm in his previous position.

“I used it off and on for a few years, started really seeing the benefits of it, and moved to using it for every surgery,” he said. “It places instruments right where you want them to be, resulting in more predictable surgeries and better outcomes.”

Geisinger performs surgery on the cervical, thoracic, and lumbar spine. He treats patients for degenerative spine conditions like spinal stenosis and herniated discs. He also treats spinal deformities like scoliosis. Surgically, Geisinger performs cervical disc replacements, minimally invasive spine surgeries, and spine surgeries needed to correct a previously unsuccessful operation. While the O-arm has other surgical applications, Geisinger uses it solely for back and neck surgeries that include spinal fusion, a procedure that involves connecting two or more vertebrae in the spine to eliminate motion between them.