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Navigate and Succeed: MI-Transforminal Lumbar Interbody Fusion with Three-Dimensional Navigation

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 28-39 | Arvind G Kulkarni, Pradhyumn Rathi, Pritem A Rajamani

DOI:10.13107/jcorth.2022.v07i01.463


Author: Arvind G Kulkarni [1], Pradhyumn Rathi [1], Pritem A Rajamani [1]

[1] Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India

Presented work performed at Saifee Hospital, Mumbai, India

Address of Correspondence
Dr. Arvind G Kulkarni,
Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India.
E-mail: drarvindspines@gmail.com


Abstract

Introduction: Lumbar Interbody Fusion (TLIF) has become a popular technique for achieving segmental interbody fusion and minimal access approach has its advantages. We have described the various Components in Spine Navigation Systems and how they have evolved in time and also describing our technique in detail. We have discussed on the advantages and disadvantages of the minimal access and use of Navigation.

Method: The authors ventured to assess the impact of 3D navigation in 117 patients that were treated with single level 3D navigated MI-TLIF in evaluating, Navigation setting time , Radiation exposure, Disc space preparation, Cage placement, Accuracy of pedicle screw placement, Cranial facet violation and Evaluation of canal decompression.

Result: Total time taken for setting up of navigation was 46.65±9.45 min. Average Radiation exposure was 5.69 mSv. In our study, the amount of disc removed was 75% in the ipsilateral anterior, 81% in ipsilateral posterior, 63% in contralateral anterior and 43% in contralateral posterior quadrants. The cage position was central in 87 patients, contralateral antero-central in six patients and ipsilateral postero-central in eight patients. The mean intraoperative blood loss was 89.65 ± 23.67 ml. Regarding accuracy 95.6% showed grade 0 and 4.4% had Grade 1 pedicle breach. Only 25 out of 408 pedicle screws (6.1%) violated the cranial facet joint. The navigation array probe was utilized to verify the adequacy of decompression and to confirm the anatomical landmarks. In our study, no surgical site infection was seen.

Conclusion: We find MIS to be associated with less post-operative infection rates as compared to open techniques. With 3D navigation, MIS becomes safer and highly accurate. MIS-TLIF with 3D navigation have satisfactory clinical outcomes and fusion rates with the additional benefits of less initial postoperative pain, less blood loss, earlier rehabilitation, and shorter hospitalization. MIS–TLIF with 3D navigation is a more cost-effective treatment than MIS-TLIF with fluoroscopy.

Keywords: Lumbar Vertebrae, Minimally Invasive Surgical Procedures, Neuronavigation, Spinal Fusion


References

  1. Eliyas JK, Karahalios D. Surgery for degenerative lumbar spine disease. Dis Mon 2011;57:592-606.
  2. Vaccaro AR, Bono CM. Minimally Invasive Spine Surgery. Florida, United States: CRC Press; 2007.
  3. Foley KT, Holly LT, Schwender JD. Minimally Invasive lumbar fusion. Spine (Phila Pa 1976) 2003;28:S26-35.
  4. Kim MC, Chung HT, Cho JL, Kim DJ, Chung NS. Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 2011;20:1635-43.
  5. Rajasekaran S, Shetty AP. Section 11, Chapter 14: Navigation in Spine Surgery; 2021.
  6. Jahng TA, Fu TS, Cunningham BW, Dmitriev AE, Kim DH. Endoscopic instrumented posterolateral lumbar fusion with healos and recombinant human growth/differentiation factor-5. Neurosurgery 2004;54:171-81.
  7. Phillips FM, Lieberman IH, Polly DW Jr., Wang MY. Minimally Invasive Spine Surgery: Surgical Techniques and Disease Management. Berlin, Germany: Springer Nature; 2020.
  8. Kambin P. Letters. Spine (Phila Pa 1976) 2004;29:598-9.
  9. Kim DH, Jaikumar S, Kam AC. Minimally invasive spine instrumentation. Neurosurgery 2002;51:S15-25.
  10. Rahmathulla G, Nottmeier EW, Pirris SM, Deen HG, Pichelmann MA. Intraoperative image-guided spinal navigation: Technical pitfalls and their avoidance. Neurosurg Focus 2014;36:E3.
  11. Guha D, Jakubovic R, Gupta S, Fehlings MG, Mainprize TG, Yee A, et al. Intraoperative error propagation in 3-dimensional spinal navigation from nonsegmental registration: A prospective cadaveric and clinical study. Global Spine J 2019;9:512-20.
  12. Rampersaud YR, Simon DA, Foley KT. Accuracy requirements for image-guided spinal pedicle screw placement. Spine (Phila Pa 1976) 2001;26:352-9.
  13. Kulkarni AG, Sagane SS, Kunder TS. Management of spondylolisthesis using MIS techniques: Recent advances. J Clin Orthop Trauma 2020;11:839-47.
  14. Hurley RK Jr., Anderson ER 3rd, Lawson BK, Hobbs JK, Aden JK, Jorgensen AY. Comparing lumbar disc space preparation with fluoroscopy versus cone beam-computed tomography and navigation: A cadaveric study. Spine (Phila Pa 1976) 2018;43:959-64.
  15. Sihvonen T, Herno A, Paljärvi L, Airaksinen O, Partanen J, Tapaninaho A. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976) 1993;18:575-81.
  16. Styf JR, Willén J. The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine (Phila Pa 1976) 1998;23:354-8.
  17. Gejo R, Matsui H, Kawaguchi Y, Ishihara H, Tsuji H. Serial changes in trunk muscle performance after posterior lumbar surgery. Spine (Phila Pa 1976) 1999;24:1023-8.
  18. Kawaguchi Y, Matsui H, Tsuji H. Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine (Phila Pa 1976) 1997;22:1018-23.
  19. Kulkarni AG, Patel RS. Is closed-suction drainage essential after minimally invasive lumbar fusion surgery?: Aretrospective review of 381 cases. J Minim Invasive Spine Surg Tech 2017;2:27-31.
  20. Kulkarni AG, Patel RS, Dutta S. Does Minimally invasive spine surgery minimize surgical site infections? Asian Spine J 2016;10:1000-6.
  21. Rajasekaran S, Bhushan M, Aiyer S, Kanna R, Shetty AP. Accuracy of pedicle screw insertion by AIRO intraoperative CT in complex  Spinal deformity assessed by a new classification based on technical complexity of screw insertion. Eur Spine J 2018; 27:2339-47.
  22. Silbermann J, Riese F, Allam Y, Reichert T, Koeppert H, Gutberlet M. Computer tomography assessment of pedicle screw  placement in lumbar and sacral spine: Comparison between free-hand and O-arm based navigation techniques. Eur Spine J 2011; 20:875-81.
  23. Meng XT, Guan XF, Zhang HL, He SS. Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw place ment: A meta-analysis. Neurosurg Rev 2016;39:385-91.
  24. Castro WH, Halm H, Jerosch J, Malms J, Steinbeck J, Blasius S. Accuracy of pedicle screw placement in lumbar vertebrae. Spine (Phila Pa 1976) 1996;21:1320-4.
  25. Baaj AA, Beckman J, Smith DA. O-Arm-based image guidance in minimally invasive spine surgery: Technical note. Clin Neurol
    Neurosurg 2013;115:342-5.
  26. Kim TT, Drazin D, Shweikeh F, Pashman R, Johnson JP. Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation. Neurosurg Focus 2014;36:E1.
  27. Rampersaud YR, Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M. Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine (Phila Pa 1976) 2000;25:2637-45.
  28. Mendelsohn D, Strelzow J, Dea N,Ford NL, Batke J, Pennington A, et al. Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation. Spine J 2016;16:343-54.
  29. O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine 2009;
    11:471-6.
  30. Nassr A. CORR Insights®: Does minimally invasive surgery have a lower risk of surgical site infections compared with open spinal surgery? Clin OrthopRelat Res 2014;472:1725-6.
  31. Lau D, Terman SW, Patel R, La Marca F, Park P. 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. J Neurosurg Spine 2013;18:356-61.
  32. Dea N, Fisher CG, Batke J, Strelzow J, Mendelsohn D, Paquette SJ, et al. Economic evaluation comparing intraoperative cone beam CT-based navigation and conventional fluoroscopy for the placement of spinal pedicle screws: A patient-level data cost-effectiveness analysis. Spine J 2016;16:23-31.
  33. Drazin D, Al-Khouja L, Shweikeh F, Pashman R, Johnson J, Kim T. Economics of image guidance and navigation in spine surgery. Surg Neurol Int 2015;6:323.
  34. Wang D, Zhang K, Qiang M, Jia X, Chen Y. Computer-assisted preoperative planning improves the learning curve of PFNA-II in the treatment of intertrochanteric femoral fractures. BMC. MusculoskeletDisord 2020;21:34.
  35. Sasso RC, Garrido BJ. Computer-assisted spinal navigation versus serial radiography and operative time for posterior spinal fusion at L5-S1. J Spinal Dis Tech 2007;20:118-22.
  36. Ryang YM, Villard J, Obermüller T, Friedrich B, Wolf P, Gempt J, et al. Learning curve of 3D fluoroscopy image-guided pedicle screw placement in the thoracolumbar spine. Spine J 2015;15:467-76.
  37. Balling H. Time demand and radiation dose in 3D-fluoroscopy-based navigation-assisted 3D-fluoroscopy-controlled pedicle screw instrumentations. Spine (Phila Pa 1976) 2018;43:E512-9.
  38. Kim CW, Lee YP, Taylor W, Oygar A, Kim WK. Use of navigation-assisted fluoroscopy to decrease radiation exposure during minimally invasive spine surgery. Spine J 2008;8:584-90.
  39. Rihn JA, Gandhi SD, Sheehan P, Vaccaro AR, Hilibrand AS, Albert TJ, et al. Disc space preparation in transforaminal lumbar interbody fusion: A comparison of minimally invasive and open approaches. Clin OrthopRelat Res 2014;472:1800-5.
  40. Castellvi AD, Thampi SK, Cook DJ, Yeager MS, Yao Y, Zou Q, et al. Effect of TLIF cage placement on in vivo kinematics. Int J Spine Surg 2015;9:38.
  41. Lian X, Navarro-Ramirez R, Berlin C, Jada A, Moriguchi Y, Zhang Q, et al. Total 3D Airo® navigation for minimally invasive transforaminal lumbar interbody fusion. Biomed Res Int 2016;2016:5027340.
  42. Xu YF, Le XF, Tian W, Liu B, Li Q, Zhang GL,et al. Computer-assisted, minimally invasive transforaminal lumbar interbody fusion: One surgeon’s learning curve a STROBE-compliant article. Medicine (Baltimore) 2018;97:e11423.
  43. Schwender JD, Holly LT, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion (TLIF): Technical feasibility and initial results. J Spinal Disord Tech 2005;18:S1-6.
  44. Chen Z, Zhao J, Xu H, Liu A, Yuan J, Wang C. Technical factors related to the incidence of adjacent superior segment facet joint violation after transpedicular instrumentation in the lumbar spine. Eur Spine J 2008;17:1476-80.
  45. Babu R, Park JG, Mehta AI, Shan T, Grossi PM, Brown CR, et al. Comparison of superior-level facet joint violations during open
    and percutaneous pedicle screw placement. Neurosurgery 2012;71:962-70.
  46. Ohba T, Ebata S, Fujita K, Sato H, Haro H. Percutaneous pedicle screw placements: Accuracy and rates of cranial facet joint violation using conventional fluoroscopy compared with intraoperative three-dimensional computed tomography computer navigation. Eur Spine J 2016;25:1775-80.
  47. Park Y, Ha JW, Lee YT, Sung NY. Cranial facet joint violations by percutaneously placed pedicle screws adjacent to a minimally invasive lumbar spinal fusion. Spine J 2011;11:295-302.
  48. Lee CK, Park JY, Zhang HY. Minimally invasive transforaminal lumbar interbody fusion using a single interbody cage and a tubular retraction system: Technical tips, and perioperative, radiologic and clinical outcomes. J Korean Neurosurg Soc 2010;48:219-24.

 

How to Cite this article: Kulkarni AG, Rathi P, Rajamani PA. Navigate and Succeed: MI-Transforminal Lumbar Interbody Fusion with Three-Dimensional Navigation. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):28-39.

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