Letter to the Editor Regarding “Comparison of Radiation Exposure Between O-Arm Navigated and C-Arm Guided Screw Placement in Minimally Invasive Transforaminal Lumbar Interbody Fusion”

2021 ◽  
Vol 150 ◽  
pp. 216-217
Author(s):  
Antonio Crea
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Letter To The Editor

Improving accuracy and reducing radiation exposure in minimally invasive lumbar interbody fusion

2010 ◽  
Vol 12 (5) ◽  
pp. 533-539 ◽  
Author(s):  
Martin James Wood ◽  
Richard John Mannion
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Interbody Fusion ◽  
Case Series ◽  
Guidance System ◽  
Screw Placement ◽  
Invasive Technique ◽  
Computer Assisted ◽  
Lumbar Interbody Fusion ◽  
Screw Misplacement

Object The authors assessed the accuracy of placement of lumbar transpedicular screws by using a computer-assisted, imaged-guided, minimally invasive technique with continuous electromyography (EMG) monitoring. Methods This was a consecutive case series with prospective assessment of procedural accuracy. Forty-seven consecutive patients underwent minimally invasive lumbar interbody fusion and placement of pedicle screws (PSs). A computer-assisted image guidance system involving CT-based images was used to guide screw placement, while EMG continuously monitored the lumbar nerve roots at the operated levels with a 5-mA stimulus applied through the pedicle access needle. All patients underwent CT scanning to determine accuracy of PS placement. All episodes of adjusted screw trajectory based on positive EMG responses were recorded. Pedicle screw misplacement was defined as breach of the pedicle cortex by the screw of more than 2 mm. Results Two hundred twelve PSs were inserted in 47 patients. The screw misplacement rate was 4.7%. One patient experienced new postoperative radiculopathy resulting from a sacral screw that was too long, with lumbosacral trunk impingement. The trajectory of the pedicle access needle was altered intraoperatively on 20 occasions (9.4% of the PSs) based on positive EMG responses, suggesting that nerve root impingement may have resulted from these screws had the EMG monitoring not been used. Conclusions The combination of computer-assisted navigation combined with continuous EMG monitoring during pedicle cannulation results in a low rate of PS misplacement, with avoidance of screw positions that might cause neural injury. Furthermore, this technique allows reduction of the radiation exposure for the surgical team without compromising the accuracy of screw placement.

scholarly journals Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 847-874 ◽  
Author(s):  
Nickalus R. Khan ◽  
Aaron J. Clark ◽  
Siang Liao Lee ◽  
Garrett T. Venable ◽  
Nicholas B. Rossi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Radiation Exposure ◽  
Interbody Fusion ◽  
Operative Time ◽  
Meta Analysis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (TLIF)—or MI-TLIF—has been increasing in prevalence compared with open TLIF (O-TLIF) procedures. The use of MI-TLIF is an evolving technique with conflicting reports in the literature about outcomes. OBJECTIVE: To investigate the impact of MI-TLIF in comparison with O-TLIF for early and late outcomes by using the Visual Analog Scale for back pain (VAS-back) and the Oswestry Disability Index (ODI). Secondary end points include blood loss, operative time, radiation exposure, length of stay, fusion rates, and complications between the 2 procedures. METHODS: During August 2014, a systematic literature search was performed identifying 987 articles. Of these, 30 met inclusion criteria. A random-effects meta-analysis was performed by using both pooled and subset analyses based on study type. RESULTS: Our meta-analysis demonstrated that MI-TLIF reduced blood loss (P < .001), length of stay (P < .001), and complications (P = .001) but increased radiation exposure (P < .001). No differences were found in fusion rate (P = .61) and operative time (P = .34). A decrease in late VAS-back scores was demonstrated for MI TLIF (P < .001), but no differences were found in early VAS-back, early ODI, and late ODI. CONCLUSION: MI-TLIF is associated with reduced blood loss, decreased length of stay, decreased complication rates, and increased radiation exposure. The rates of fusion and operative time are similar between MI-TLIF and O-TLIF. Differences in long-term outcomes in MI-TLIF vs O-TLIF are inconclusive and require more research, particularly in the form of large, multi-institutional prospective randomized controlled trials.

scholarly journals Intraoperative Three-Dimensional Navigation Versus Fluoroscopy: A Comparison of Time Demand, Radiation Exposure, and Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Avani Vaishnav ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
Todd Albert ◽  
Catherine Gang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Interbody Fusion ◽  
Image Acquisition ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fluoroscopy Time ◽  
Anesthesia Induction ◽  
Lumbar Interbody Fusion ◽  
Continuous Variables ◽  
Time Required

Abstract INTRODUCTION Intraoperative navigation (ION) is increasingly being utilized to provide better visualization and enable less invasive procedures. However, it is associated with upfront costs, intraoperative time-demand and potentially greater radiation exposure. The purpose of this study was to compare time-demand, radiation exposure and outcomes of 3-dimensional (3D) ION using a skin-anchored tracker and conventional 2-dimensional (2D) fluoroscopy in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). METHODS A retrospective review of patients who underwent 1-level MI-TLIF by a single surgeon from 2011 to 2018 was performed. Demographics, operative factors, and radiation exposure were compared using chi square test for categorical and t-test for continuous variables. RESULTS Of the 169 patients, 94 underwent MI-TLIF using fluoroscopy and 75 using ION. There were no differences in demographics or level of surgery. The time required for ION set-up, measured as the time from completion of anesthesia induction to the start of surgery was a median of 24 min. This accounts for time required for patient positioning, preparing, and draping the incision site, placing the skin-anchored navigation tracker and acquiring an image for real-time navigation. ION resulted in shorter operative time (P < .0001) and less blood loss (P = .007). Although ION required additional time for image acquisition, total time-demand (image acquisition + surgical procedure) was only slightly greater than that of the procedure alone using fluoroscopy (median 113 vs 108 min, P = .044). ION also resulted in reduced fluoroscopy time (median 26 vs 144 s, P < .0001) and radiation dose (median 44.6 vs 63.1 mGy, P = .002). There were no wrong-level surgeries in either cohort. CONCLUSION The use of skin-based ION is feasible, safe, and accurate. It does not substantially increase the time-demand and results in decreased operative times, fluoroscopy time, and radiation exposure compared to traditional fluoroscopy.

Incidence of and risk factors for superior facet violation in minimally invasive versus open pedicle screw placement during transforaminal lumbar interbody fusion: a comparative analysis

2013 ◽  
Vol 18 (4) ◽  
pp. 356-361 ◽  
Author(s):  
Darryl Lau ◽  
Samuel W. Terman ◽  
Rakesh Patel ◽  
Frank La Marca ◽  
Paul Park
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw

Object A reported risk factor for adjacent-segment disease is injury to the superior facet joint from pedicle screw placement. Given that the facet joint is not typically visualized during percutaneous pedicle screw insertion, there is a concern for increased facet violation (FV) in minimally invasive fusion procedures. The purpose of this study was to analyze and compare the incidence of FV among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open transforaminal lumbar interbody fusion (TLIF). The impact of O-arm navigation compared with traditional fluoroscopy on FV in MITLIF is also assessed, as are risk factors for FV. Methods The authors identified a consecutive population of patients who underwent MITLIF with percutaneous pedicle screw placement, as well as a matched cohort of patients who underwent open TLIF. Postoperative CT imaging was assessed to determine intraarticular FV due to pedicle screw placement. Patients were stratified into minimally invasive and open TLIF groups. Within the MITLIF group, the authors performed a subanalysis of image guidance methods used in cases of FV. Two-tailed Student t-test, ANOVA, chi-square testing, and logistic regression were used for statistical analysis. Results A total of 282 patients were identified, with a total of 564 superior pedicle screw placements. The MITLIF group consisted of 142 patients with 284 screw insertions. The open TLIF group consisted of 140 patients with 280 screw insertions. Overall, 21 (7.4%) of 282 patients experienced FV. A total of 21 screws violated a facet joint for a screw-based FV rate of 3.7% (21 of 564 screws). There were no significant differences between the MITLIF and open TLIF groups in the percentage of patients with FV (6.3% vs 8.6%) and or the percentage of screws with FV (3.2% vs 4.3%) (p = 0.475 and p = 0.484, respectively). Further stratifying the MI group into O-arm navigation and fluoroscopic guidance subgroups, the patient-based rates of FV were 10.8% (4 of 37 patients) and 4.8% (5 of 105 patients), respectively, and the screw-based rates of FV were 5.4% (4 of 74 screws) and 2.4% (5 of 210 screws), respectively. There was no significant difference between the subgroups with respect to patient-based or screw-based FV rates (p = 0.375 and p = 0.442, respectively). The O-arm group had a significantly higher body mass index (BMI) (p = 0.021). BMI greater than 29.9 was independently associated with higher FV (OR 2.36, 95% CI 1.65–8.53, p = 0.039). Conclusions The findings suggest that minimally invasive pedicle screw placement is not associated with higher rates of FV. Overall violation rates were similar in MITLIF and open TLIF. Higher BMI, however, was a risk factor for increased FV. The use of O-arm fluoroscopy with computer-assisted guidance did not significantly decrease the rate of FV.

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