Use of 3D CT-based navigation in minimally invasive lateral lumbar interbody fusion.
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS LLIF can be safely and accurately performed utilizing iCBCT and IGNS. Accuracy is acceptable for multilevel procedures.
Departments of 1 Neurosurgery and.
Jacob R
JR
Joseph
Departments of 1 Neurosurgery and.
Brandon W
BW
Smith
Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan.
Rakesh D
RD
Patel
Departments of 1 Neurosurgery and.
Paul
P
Park
D000328:Adult; D000368:Aged; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
ASIS = anterior superior iliac spine; DLIF; IGNS = image-guided navigation system; LFCN = lateral femoral cutaneous nerve; LLIF = lateral lumbar interbody fusion; O-arm Surgical Imaging System; PSIS = posterior superior iliac spine; XLIF; iCBCT = intraoperative cone-beam CT; image-guided spinal navigation; lateral lumbar interbody fusion; minimally invasive spine surgery