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

Abstract

The oblique lumbar interbody fusion (OLIF) can be done with either fluoroscopy or navigation. However, it is unclear how navigation affects the overall flow of the procedure. We wished to report on the accuracy of this technique using navigation and on how navigation affects surgical time and complications. Methods: A retrospective review was undertaken to evaluate patients who underwent OLIF using spinal navigation at University of California San Francisco. Data collected were demographic variables, perioperative variables, and radiographic images. Postoperative lateral radiographs were analyzed for accuracy of cage placement. The disc space was divided into 4 quadrants from anterior to posterior, zone 1 being anterior, and zone 4 being posterior. The accuracy of cage placement was assessed by placement. Results: There were 214 patients who met the inclusion criteria. A total of 350 levels were instrumented from L1 to L5 using navigation. The mean follow-up time was 17.42 months. The mean surgical time was 211 minutes, and the average surgical time per level was 129.01 minutes. After radiographic analysis, 94.86% of cages were placed within quartiles 1 to 3. One patient (0.47%) underwent revision surgery because of suboptimal cage placement. For approach-related complications, transient neurological symptoms were 10.28%, there was no vascular injury. Conclusion: The use of navigation to perform OLIF from L1 to L5 resulted in a cage placement accuracy rate of 94.86% in 214 patients.

Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review

“…The use of intraoperative stereotactic navigation systems and robotic assistance in OLIF has increased recently [ 20 ], as has the evidence on these technical advancements, which can improve surgical accuracy and patient outcomes. Xi et al [ 93 ] published the results of 214 navigated OLIF cases and reported a cage placement accuracy rate of 94.86%. Only one patient underwent a revisional operation due to cage misplacement, and there was no vascular injury in their series.…”

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

“…Xi et al demonstrated that use of CaN for the oblique lumbar interbody fusion (OLIF) technique resulted in an accuracy rate of 94.9%, as assessed by postoperative lateral radiographs. 18 Whereas Xi et al evaluated only OLIF, in our study we had 1 misplaced interbody cage requiring intraoperative modification using the LLIF technique, which we attributed to CaN inaccuracy. This single incident suggests that use of CaN for placement of lateral lumbar interbody cages in the adult spinal deformity population is safe and accurate.…”

Radiation Dose Reduction and Surgical Efficiency Improvement in Endoscopic Transforaminal Lumbar Interbody Fusion Assisted by Intraoperative O-arm Navigation: A Retrospective Observational Study

“…The advent and development of navigation technology have had a profound impact on spinal surgery. 22,23 Computer-assisted 3D navigation can provide high-resolution images and a more detailed view of the pedicles, improving the precision of spinal screw placement. As reported in a previous study, the nerve injury risk and clinical complications could be decreased through this technique.…”

“…However, as a less invasive surgery than MIS-TLIF, there are many other percutaneous procedures in Endo-TLIF besides percutaneous screw placement, leading to more radiation exposure. The advent and development of navigation technology have had a profound impact on spinal surgery [ 22 , 23 ]. Computer-assisted 3D navigation can provide high-resolution images and a more detailed view of the pedicles, improving the precision of spinal screw placement.…”