Comparing Lumbar Disc Space Preparation With Fluoroscopy Versus Cone Beam-Computed Tomography and Navigation

Hurley, Richard K.; Anderson, Edward R.; Lawson, Bryan K.; Hobbs, Joseph; Aden, James K; Jorgensen, Anton

doi:10.1097/brs.0000000000002526

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…In our study, the navigation array probe was utilized to verify the adequacy of decompression and to confirm the anatomical landmarks as and when necessary. In their study on 28 patients undergoing MIS TLIF, Lee et al found that the mean spinal canal cross section area at disc spaces has increased s i g n i f i c a n t l y a t 1 2 m o n t h s postoperatively from 157.5 mm2 to 294.3 mm2, (P= 0.012) leading to a good clinical outcome, which could easily be evaluated intraoperatively using the navigation like in our study [14,48].…”

Section: Evaluation Canal Decompressionsupporting

confidence: 55%

“…The completeness of excision of the intervertebral disc is evaluated by introducing the navigation array probe in all directions contralateral posterior, anterior and ipsilateral anterior, posterior quadrants of disc space (Fig. 5) [14]. Once disc space is cleared of the remnant disc, superior, and inferior cartilaginous endplates are curetted till superficial bleeding appears on the bed of endplates to promote fusion.…”

Section: Disc Space Preparationmentioning

confidence: 99%

“…[14] compared the area of empty disc space between two techniques; cone beam navigation and open technique using a navigation probe. D i s c re m o v e d u s i n g c o n e b e a m navigation was ipsilateral-anterior = 75 % , i p s i l a t e r a l -p o s t e r i o r = 8 1 % , contralateral-anterior = 63% and contralateral-posterior = 43%.…”

mentioning

confidence: 99%

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Navigate and Succeed: MI-Transforminal Lumbar Interbody Fusion with Three-Dimensional Navigation

Kulkarni¹,

Rathi²,

Rajamani³

2022

Jcorth

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Introduction: Lumbar Interbody Fusion (TLIF) has become a popular technique for achieving segmental interbody fusion and minimal access approach has its advantages. We have described the various Components in Spine Navigation Systems and how they have evolved in time and also describing our technique in detail. We have discussed on the advantages and disadvantages of the minimal access and use of Navigation. Method: The authors ventured to assess the impact of 3D navigation in 117 patients that were treated with single level 3D navigated MI-TLIF in evaluating, Navigation setting time , Radiation exposure, Disc space preparation, Cage placement, Accuracy of pedicle screw placement, Cranial facet violation and Evaluation of canal decompression. Result: Total time taken for setting up of navigation was 46.65±9.45 min. Average Radiation exposure was 5.69 mSv. In our study, the amount of disc removed was 75% in the ipsilateral anterior, 81% in ipsilateral posterior, 63% in contralateral anterior and 43% in contralateral posterior quadrants. The cage position was central in 87 patients, contralateral antero-central in six patients and ipsilateral postero-central in eight patients. The mean intraoperative blood loss was 89.65 ± 23.67 ml. Regarding accuracy 95.6% showed grade 0 and 4.4% had Grade 1 pedicle breach. Only 25 out of 408 pedicle screws (6.1%) violated the cranial facet joint. The navigation array probe was utilized to verify the adequacy of decompression and to confirm the anatomical landmarks. In our study, no surgical site infection was seen. Conclusion: We find MIS to be associated with less post-operative infection rates as compared to open techniques. With 3D navigation, MIS becomes safer and highly accurate. MIS-TLIF with 3D navigation have satisfactory clinical outcomes and fusion rates with the additional benefits of less initial postoperative pain, less blood loss, earlier rehabilitation, and shorter hospitalization. MIS–TLIF with 3D navigation is a more cost-effective treatment than MIS-TLIF with fluoroscopy.

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Section: Evaluation Canal Decompressionsupporting

confidence: 55%

Section: Disc Space Preparationmentioning

confidence: 99%

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Navigate and Succeed: MI-Transforminal Lumbar Interbody Fusion with Three-Dimensional Navigation

Kulkarni¹,

Rathi²,

Rajamani³

2022

Jcorth

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“…However, in terms of endplate preparation, there were no significant differences (P > 0.05) between the device and manual discectomy groups [5]. Another recent cadaveric research found that there a higher disc space preparation rate using the CT-navigation guidance, especially in the anterior contralateral and posterior contralateral quadrants [14]. But, in terms of procedure duration, instrument passage times, and endplate violation rate, there were no significant differences (P > 0.05) between the two groups [14].…”

Section: Discussionmentioning

confidence: 89%

A pilot study of endoscope-assisted MITLIF with fluoroscopy-guided technique: intraoperative objective and subjective evaluation of disc space preparation

et al. 2022

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Background Adequate discectomy and endplate preparation are extremely crucial steps for spinal interbody fusion. Minimally invasive transforaminal lumbar interbody fusion MITLIF technique is safe and effective. However, concerns exist regarding sufficient disc space preparation from unilateral access. The purpose of this study, was to demonstrate our preliminary experience in objective and subjective evaluation of disc space preparation intraoperatively during endoscope-assisted MITLIF with fluoroscopy-guided, describing some of its possible advantages, and analyzing its safety and feasibility. Methods From March 2018 to July 2019, three patients with degenerative spinal stenosis with radiculopathy and instability underwent endoscope-assisted MITLIF with fluoroscopy-guided. Patients’ demographic data, clinical parameters, subsidence, and fusion were collected. Results Patients were successfully treated by endoscope-assisted MITLIF with fluoroscopy-guided at single-level or two-level. Symptoms improved postoperatively in all patients, and no complications occurred during follow-up. No cage subsidence was observed. At 6-month postoperatively, there was bony fusion observed on computed tomography in two patients. Conclusion Endoscope-assisted MITLIF with fluoroscopy-guided is a safe and feasible technique to improve visualization during discectomy and endplate preparation objectively and subjectively, possibly increasing fusion rate and early time to fusion.

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“…The completeness of excision of the intervertebral nucleus pulposus and cartilaginous endplate was evaluated by introducing the navigation array probe in all directions: contralateral posterior (Figure 1), contralateral anterior (Figure 2), ipsilateral anterior, and ipsilateral posterior 10 (Figure 3). The superior and inferior endplates were grated in all possible trajectories.…”

Section: Surgical Technique Under 3d-navigationmentioning

confidence: 99%

Multimodal Applications of 3D-Navigation in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: Impacts on Precision, Accuracy, Complications, and Radiation Exposure

et al. 2022

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Background: Three-dimensional (3D)-navigation in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is an evolving procedure. It is used not only for its accuracy of pedicle screw fixation but also for other major steps in transforaminal lumbar interbody fusion. Multimodal outcomes of this procedure are very limited in the literature. The purpose of this study was to examine the application of 3D-navigation in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).Methods: Patients who underwent single-level MI-TLIF using 3D-navigation between January 2017 and July 2019 were evaluated for navigation setting time, radiation exposure, volume of nucleus pulposus excised, cage placement, accuracy of pedicle screw placement, and cranial facet-joint violation.Results: One hundred and two patients with a mean age of 60.2 years met the inclusion criteria. The mean presetting time of navigation was 46.65 ± 9.45 minutes. Radiation exposure, fluoroscopy use, and fluoroscopy time were 15.54 ± 0.65 mGy, 4.43 ± 0.87 Gy. cm², and 97.6 ± 11.67 seconds, respectively. The mean amount of nucleus pulposus excised from all quadrants was quantified. The cage was centrally placed in 87 patients, with 95.4% showing a Grade 0 pedicle breach and 94.6% showing Grade 0 cranial facet-joint violation.Conclusion: Registration and setting up 3D-navigation takes additional time. The amount of exposure to the patient is much less compared to routine computed tomography, and, importantly, the operating team is protected from radiation. Navigated MI-TLIF has high rates of accuracy with regard to placement of percutaneous pedicle screws and cages with the added advantage of protection of the cranial facet-joint.

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Comparing Lumbar Disc Space Preparation With Fluoroscopy Versus Cone Beam-Computed Tomography and Navigation

Abstract: 5.

Cited by 7 publications

References 10 publications

Navigate and Succeed: MI-Transforminal Lumbar Interbody Fusion with Three-Dimensional Navigation

Navigate and Succeed: MI-Transforminal Lumbar Interbody Fusion with Three-Dimensional Navigation

A pilot study of endoscope-assisted MITLIF with fluoroscopy-guided technique: intraoperative objective and subjective evaluation of disc space preparation

Multimodal Applications of 3D-Navigation in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: Impacts on Precision, Accuracy, Complications, and Radiation Exposure

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