Total 3D Airo® Navigation for Minimally Invasive Transforaminal Lumbar Interbody Fusion

Abstract

Introduction. A new generation of iCT scanner, Airo®, has been introduced. The purpose of this study is to describe how Airo facilitates minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Method. We used the latest generation of portable iCT in all cases without the assistance of K-wires. We recorded the operation time, number of scans, and pedicle screw accuracy. Results. From January 2015 to December 2015, 33 consecutive patients consisting of 17 men and 16 women underwent single-level or two-level MIS-TLIF operations in our institution. The ages ranged from 23 years to 86 years (mean, 66.6 years). We treated all the cases in MIS fashion. In four cases, a tubular laminectomy at L1/2 was performed at the same time. The average operation time was 192.8 minutes and average time of placement per screw was 2.6 minutes. No additional fluoroscopy was used. Our screw accuracy rate was 98.6%. No complications were encountered. Conclusions. Airo iCT MIS-TLIF can be used for initial planning of the skin incision, precise screw, and cage placement, without the need for fluoroscopy. “Total navigation” (complete intraoperative 3D navigation without fluoroscopy) can be achieved by combining Airo navigation with navigated guide tubes for screw placement.

Minimally Invasive Spine Surgery in the Nuevo Hospital Civil De Guadalajara "Dr. Juan I. Menchaca"

“…[1][2][3][4][5][6][7][8][9][10][11][16][17][18] These objectives are achieved through conventional spinal approaches that involve the detachment of the paraspinal musculature, its denervation and devascularization, in addition to injury to the ligamentary structures, in contrast to minimally invasive techniques, which try to minimize the damage to these structures. Minimally invasive techniques are able to limit exposure as much as possible and to reduce the retraction of the structures, resulting in the less collateral damage to the tissues, a measurable reduction in morbidity, and above all, a more rapid functional recovery without departing from the primary objective established for spine surgery.…”

“…Several prior studies established a valid justification for this type of procedure in terms of their similar results in neurological outcomes and the preservation of structures that are essential to the biomechanics of the spine. [1][2][3][4][5][6][7][8][9][10][11][16][17][18] Minimally invasive approaches have been developed for degenerative, traumatic, and neoplastic pathologies, among others.…”

“…[1][2][3][4][5][6][7][8][9][10][11] The particular characteristics of spine surgery require advances to be made prudently and more safely than in surgeries in other regions of the human body. In spite of the existing difficulties, the possibility of using techniques labeled "minimally invasive" in the spine is perhaps more important and sustainable than in other parts of the organism.…”

“…2 Approaches from the posterior part of the spine severely injure the posterior musculature with irrecoverable denervation and are a significant cause of surgical failure. 1,[3][4][5][6][7][8][9][10][11] Anterior spinal approaches require thoracotomies, laparotomies, lumbotomies, etc., all of which offer broad exposure but also severe injury to the adjacent tissues with undesirable, and sometimes definitive, secondary effects. [12][13][14][15] It is important to achieve outcomes similar to those of conventional surgery without most of its inconveniences of unnecessary damage to adjacent tissues.…”

Advantages and Disadvantages of Multi-axis Intraoperative Angiography Unit for Percutaneous Pedicle Screw Placement in the Lumbar Spine

“…Recently, surgical support devices used when inserting pedicle screws have been undergoing rapid development, and performing more accurate and minimally invasive surgery has become possible by (i) combining a navigation system with a mobile fluoroscope that can acquire three-dimensional images, such as the Arcadis Orbic Isocentric C-arm (Siemens Healthcare, Germany) 3,4) or the O-arm (Medronic, USA), 5–7) or (ii) combining a navigation system with a Computed tomography (CT) device 8,9) or the mobile CT device Airo (Brainlab AG, Germany). 10) In this study, we used a hybrid operating room (OR) equipped with a multi-axis angiography unit (Artis Zeego, Siemens Healthcare, Germany), which is capable of obtaining high-quality intraoperative fluoroscopic images over a broad area and can capture CT-like images. Moreover, fluoroscopy operations were also facilitated by storing set angles and positions.…”