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

Abstract

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.