Comparison Perioperative Factors During Minimally Invasive Pre-Psoas Lateral Interbody Fusion of the Lumbar Spine Using Either Navigation or Conventional Fluoroscopy

Abstract

Study Design:Retrospective clinical study.Objectives:The aim of this study was to compare intraoperative conditions and clinical results of patients undergoing pre-psoas oblique lateral interbody fusion (OLIF) using navigation or conventional fluoroscopy (C-ARM) techniques.Methods:Forty-two patients (22 patients by navigation and 20 by fluoroscopy) underwent the OLIF procedure at 2 medical centers, and records were reviewed. Clinical data was collected and compared between the 2 groups. Patients were followed-up with a range of 6 to 24 months.Results:There were no significant differences on demographic data between groups. The navigation group had zero radiation exposure (RE) to the surgeon and radiation time compared to the C-ARM group, with total RE of 44.59 ± 26.65 mGy and radiation time of 88.30 ± 58.28 seconds (P < .05). The RE to the patient was significantly lower in the O-ARM group (9.38 mGy) compared to the C-ARM group (44.59 ± 26.65 mGy). Operating room time was slightly longer in the navigation group (2.49 ± 1.35 hours) compared to the C-ARM group (2.30 ± 1.17 hours; P > .05), although not statistically significant. No differences were found in estimated blood loss, length of hospitalization, surgery-related complications, and outcome scores with an average of 8-month follow-up.Conclusions:Compared with C-ARM techniques, using navigation can eliminate RE to surgeon and decrease RE to the patient, and it had no significant effect on operating time, estimated blood loss, length of hospitalization, or perioperative complications in the patients with OLIF procedure. This study shows that navigation is a safe alternative to fluoroscopy during the OLIF procedure in the treatment of degenerative lumbar conditions.

The Navigated Oblique Lumbar Interbody Fusion: Accuracy Rate, Effect on Surgical Time, and Complications

“…Although there have been previous publications on OLIF and navigation, most of these papers did not specifically report cage placement accuracy. 5,6,27 However, Joseph et al, 7 Liu et al, 8 and Park 9 have previously reported navigation accuracy in LLIF surgery, and our findings are consistent with their previously reported accuracy rates. One issue, however, is the added radiation exposure to the patient with the second O-Arm spin for the pedicle screw fixation.…”

“…2). 5 With regards to percutaneous screw fixation, the patient was subsequently positioned prone either on the same day or a subsequent date, depending on how extensive the surgery was. A reference arc was placed either in the iliac crest or on the spinous process, and another O-Arm spin was performed to register the navigation.…”

“…3 Historically, lateral lumbar interbody fusion (LLIF) has been done with a true lateral view under fluoroscopy, but the OLIF is done from an oblique trajectory. 4,5 This oblique angle can be somewhat disorienting for surgeons, and navigation may be one method to help abate this disorientation. 6 Although navigation has been reported as an alternative to fluoroscopy to perform the OLIF, there is limited data as to the accuracy of navigated OLIF in a large number of patients.…”

“…6 Although navigation has been reported as an alternative to fluoroscopy to perform the OLIF, there is limited data as to the accuracy of navigated OLIF in a large number of patients. 5 We wished to report how navigation affects the OLIF accuracy, complications, and surgical time.…”

Perspective review on applications of optics in spinal surgery

“…38 Adoption of CAN by spinal surgeons is further limited by concerns over temporal efficiency, particularly as a result of cumbersome registration workflow. 40 In a comparative study of O-arm (3-D CBCT) versus fluoroscopy guidance for MIS lateral interbody lumbar fusions, Zhang et al 41 demonstrated a statistically insignificant increase in operative time with CAN guidance. In larger in vivo studies, both Rajasekaran et al 42 and Tabaraee et al 43 found time-equivalence for 3-D CBCT-based navigation versus fluoroscopy for the placement of posterior thoracolumbar pedicle screws.…”