title: Three-dimensional computed tomography-based spinal navigation in minimally invasive lateral lumbar interbody fusion: feasibility, technique, and initial results.
abstract: BACKGROUND
  As with most minimally invasive spine procedures, lateral lumbar interbody fusion (LLIF) requires the use of biplanar fluoroscopy for localization and safe interbody cage placement. Computed tomography (CT)-based intraoperative spinal navigation has been shown to be more effective than fluoroscopic guidance for posterior-based approaches such as pedicle screw instrumentation. However, the use of spinal navigation in LLIF has not been well studied.
  
  
  OBJECTIVE
  To present the technique for using an intraoperative cone-beam CT and image-guided navigation system in LLIF and to provide a preliminary analysis of outcomes.
  
  
  METHODS
  We retrospectively analyzed a prospectively acquired database and the electronic records of patients undergoing LLIF with spinal navigation. Eight patients were identified. Postoperative neurological deficits were recorded. All patients underwent postprocedural CT and x-ray imaging for analysis of accuracy of cage placement. Accuracy of cage placement was determined by location within the disk space.
  
  
  RESULTS
  The mean age was 66 years, and 6 patients were women. A mean 2.8 levels were treated with a total of 22 lateral cages implanted via navigation. All cages were placed within quarters 1 to 2 or 2 to 3, signifying the anterior half or middle portions of the disk space. There were no sensory or motor deficits postoperatively.
  
  
  CONCLUSIONS
  Use of an intraoperative cone-beam CT with an image-guided navigation system is feasible and safe and appears to be accurate, although a larger study is required to confirm these results.
authors: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
authors: Paul
authors: P
authors: Park
mesh_terms: D000368:Aged; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*