The usefulness and safety of the simultaneous parallel anterior and posterior combined lumbar spine surgery using intraoperative 3D fluoroscopy-based navigation (SPAPS)

Abstract

Background: The combined anterior-posterior surgery in the lateral decubitus position generally needs the intraoperative repositioning. However, prolonged surgical time and increased medical costs due to intraoperative repositioning have been problematic. In recent years, there have been reports of combined anterior-posterior procedure with a single position performing anterior and posterior fixation consecutively where the patient remains in the lateral decubitus position (single surgeon method-SS method). We had further advanced this method, and have adopted the S imultaneous P arallel A nterior and P osterior combined lumbar spine S urgery using intraoperative 3D fluoroscopy-based navigation (SPAPS method), where anterior and posterior procedure are performed independently by two spine surgeons.Methods: 66 cases that underwent SPAPS method (n = 37) and SS method (n = 29) from 2015 to 2019 at single institution were concluded in this study. The pre-and post-operative changes in the following were compared retrospectively between the two groups: surgical factors and clinical evaluations including JOA back pain evaluation questionnaire (JOABPEQ), visual analogue scale (VAS) on lower back pain, buttock/lower limb pain, and buttock/lower limb numbness, and Roland-Morris disability questionnaire (RDQ). Results:The SPAPS method was able to significantly reduce the surgical time (p = 0.0025) compared to the SS method, and allowed a reduction of approximately 24.4 minutes per segment. The estimated blood loss were similar in both groups, and with regards to post-operative outcomes, both groups improved equally well. The rates of screw deviation and fusion were also similar. Conclusions:In the case of performing the combined anterior-posterior surgery under a single position, the anterior and posterior procedure can be performed independently and simultaneously by two spine surgeons by utilizing the 3D fluoroscopy-based navigation. The surgical time can be significantly reduced by approximately 24.4 minutes per segment comparing to the SS method.

The one-stop-shop approach: Navigating lumbar 360-degree instrumentation in a single position

“…Sellin et al applied CT-guided navigation for simultaneous lateral interbody fusion and pedicle screw placement in lateral positioning showing reduced radiation exposure and reduced duration of surgery, especially as intraoperative navigation replaced intraoperative fluoroscopy and therefore allowed the parallel execution of both procedures ( 32 ). Ikuma et al compared single-positioning surgery in a right lateral decubitus positioning for cases with and without spinal navigation, showing a significantly reduced duration of surgery for cases with spinal navigation as spinal navigation partially enabled simultaneous anterior and posterior instrumentation ( 33 ).…”

Single-Position Lateral Approach for Revision Thoracolumbar Corpectomy With Delayed Ipsilateral Kidney Atrophy: Technical Note and Discussion of Complications

“…Single-position spine surgery is an increasingly utilized approach for surgeons aiming to maximize efficiency in the operating room. Improvements in navigation technology, such as robotics-assisted navigation and intraoperative 3D fluoroscopy-based navigation, have particularly enabled surgeons to quickly and safely offer single-position procedures [1][2][3]. Single position techniques for lumbar fusion have resulted in shorter operating times and a reduced length of stay (LOS) as compared to traditional lateral and prone dual position surgeries [4].…”