Use of 3D CT-based navigation in minimally invasive lateral lumbar interbody fusion

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Lateral lumbar interbody fusion (LLIF) is an increasingly popular technique used to treat degenerative lumbar disease. The technique of using an intraoperative cone-beam CT (iCBCT) and an image-guided navigation system (IGNS) for LLIF cage placement has been previously described. However, other than a small feasibility study, there has been no clinical study evaluating its accuracy or safety. Therefore, the purpose of this study was to evaluate the accuracy and safety of image-guided spinal navigation in LLIF.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>An analysis of a prospectively acquired database was performed. Thirty-one consecutive patients were identified. Accuracy was initially determined by comparison of the planned trajectory of the IGNS with post–cage placement intraoperative fluoroscopy. Accuracy was subsequently confirmed by postprocedural CT and/or radiography. Cage placement was graded based on a previously described system separating the disc space into quarters.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The mean patient age was 63.9 years. A total of 66 spinal levels were treated, with a mean of 2.1 levels (range 1–4) treated per patient. Cage placement was noted to be accurate using IGNS in each case, as confirmed with intraoperative fluoroscopy and postoperative imaging. Sixty-four (97%) cages were placed within Quarters 1 to 2 or 2 to 3, indicating placement of the cage in the anterior or middle portions of the disc space. There were no instances of misguidance by IGNS. There was 1 significant approach-related complication (psoas muscle abscess) that required intervention, and 8 patients with transient, mild thigh paresthesias or weakness.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>LLIF can be safely and accurately performed utilizing iCBCT and IGNS. Accuracy is acceptable for multilevel procedures.</jats:p></jats:sec>

Intraoperative navigation for accurate midline placement of anterior lumbar interbody fusion and total disc replacement prosthesis

“…Park 2015 found that this method of navigation was safe, feasible and appeared to be accurate in LLIF procedures (8). This finding is similar to that of Joseph et al, who also used intraoperative CT and an image-guided navigation system for LLIF cage placement (16). A literature review of 26 prospective clinical trials also found that the percentage of inserted screws contained within the pedicle was 89% to 100% when using CT navigation (15).…”

“…Similar results have been found in several reports using CT-based spinal navigation with lateral lumbar interbody fusion (LLIF) (8,16). The use of CT navigation with anterior lumber interbody fusion (ALIF) has also been shown to provide greater accuracy and less variation in device placement, though only in cadaveric models (14).…”

Is bony attachment necessary for dynamic reference frame in navigation-assisted minimally invasive lumbar spine fusion surgery?

“…Accuracy results for 50 patients (95%) who had all pedicle screws installed with computer assistance proved statistically better than results for a control group of 100 patients (85%) instrumented with a conventional technique using biplanar fluoroscopy [16]. Similar screw placement accuracies are reported in multiple recent studies with navigation-assistance, all using postoperative CT scan to determine the screw placement accuracy [11,12,[17][18][19][20]. Most studies reported 98% to 99% of their screws being placed within a 2 mm pedicle breach margin despite slightly different methods of screw placement.…”

“…Computerized tomography-based spinal image guidance has evolved from paired point matching, paired point matching combined with surface matching [9], three dimensional rotational X-ray [10], three dimensional CT based navigation [11]. The accuracy of the navigation system depending on the integrity of the connected components of the system, and the stability of DRF, which are the critical parts of navigation surgery.…”

“…The accuracy of the navigation system depending on the integrity of the connected components of the system, and the stability of DRF, which are the critical parts of navigation surgery. Traditionally, the DRF is fixed in the spinal process [12] or PSIS [5,11] to prevent the movement, synchronization of the visual data set, and the actual anatomical positions. However, placement of DRF on PSIS may require another separate incision wound, hinder the surgical procedure, interfering with the navigation, and compromising the accuracy in MIS TLIF [13].…”