The feasibility of computer-assisted 3D navigation in multiple-level lateral lumbar interbody fusion in combination with posterior instrumentation for adult spinal deformity

Abstract

OBJECTIVEThe lateral lumbar interbody fusion (LLIF) technique is used to treat many common spinal degenerative pathologies including kyphoscoliosis. The use of spinal navigation for LLIF has not been broadly adopted, especially in adult spinal deformity. The purpose of this study was to evaluate the feasibility as well as the intraoperative and navigation-related complications of computer-assisted 3D navigation (CaN) during multiple-level LLIF for spinal deformity.METHODSRetrospective analysis of clinical and operative characteristics was performed for all patients > 18 years of age who underwent multiple-level CaN LLIF combined with posterior instrumentation for adult spinal deformity at the University of Michigan between 2014 and 2020. Intraoperative CaN-related complications, LLIF approach–related postoperative complications, and medical postoperative complications were assessed.RESULTSFifty-nine patients were identified. The mean age was 66.3 years (range 42–83 years) and body mass index was 27.6 kg/m2 (range 18–43 kg/m2). The average coronal Cobb angle was 26.8° (range 3.6°–67.0°) and sagittal vertical axis was 6.3 cm (range −2.3 to 14.7 cm). The average number of LLIF and posterior instrumentation levels were 2.97 cages (range 2–5 cages) and 5.78 levels (range 3–14 levels), respectively. A total of 6 intraoperative complications related to the LLIF stage occurred in 5 patients. Three of these were CaN-related and occurred in 2 patients (3.4%), including 1 misplaced lateral interbody cage (0.6% of 175 total lateral cages placed) requiring intraoperative revision. No patient required a return to the operating room for a misplaced interbody cage. A total of 12 intraoperative complications related to the posterior stage occurred in 11 patients, with 5 being CaN-related and occurring in 4 patients (6.8%). Univariate and multivariate analyses revealed no statistically significant risk factors for intraoperative and CaN-related complications. Transient hip weakness and numbness were found to be in 20.3% and 22.0% of patients, respectively. At the 1-month follow-up, weakness was observed in 3.4% and numbness in 11.9% of patients.CONCLUSIONSUse of CaN in multiple-level LLIF in the treatment of adult spinal deformity appears to be a safe and effective technique. The incidence of approach-related complications with CaN was 3.4% and cage placement accuracy was high.

Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review

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Navigated versus conventional pediatric spinal deformity surgery: Navigation independently predicts reoperation and infectious complications

“…While current research has demonstrated positive clinical satisfaction and radiographic accuracy with the use of navigation for treating degenerative disease, literature on treating pediatric deformity with navigation is limited, particularly using large nationally represented cohorts. [ 11 12 ] Further, comparison of single-institution data to national-level database outcomes is also limited. Such comparison could provide insight into learning curves and technique-related factors associated with better outcomes.…”

X23D—Intraoperative 3D Lumbar Spine Shape Reconstruction Based on Sparse Multi-View X-ray Data

“…Computer-assisted surgical (CAS) navigation techniques have been introduced as means to facilitate and standardize such interventions by providing 3D intraoperative spatial guidance and were shown to result in substantially higher pedicle screw-insertion accuracy compared to free-hand and conventional 2D fluoroscopy-guided methods [ 3 , 15 , 16 ]. Furthermore, CAS technologies have also been used for cage-insertion purposes [ 17 ] and have been shown to result in improved performance [ 18 ]. The most common CAS systems still rely on preoperative 3D imaging [ 19 ] and preoperative planning, which allows for the generation of patient-specific models (bio-mechanical digital twins), which can be used as the basis for computer simulations helping to determine and optimize surgery plans.…”