Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Oper Neurosurg (Hagerstown). 2018 Jun 1;14(6):620-626. doi: 10.1093/ons/opx176.
Minimally invasive lateral lumbar interbody fusion (LLIF) is traditionally performed with biplanar fluoroscopy. Recent literature demonstrates that intraoperative cone-beam computed tomography combined with spinal navigation can be safely utilized for localization and cage placement in LLIF.
To evaluate the accuracy and safety of cage placement using spinal navigation in LLIF, as well as to evaluate the radiation exposure to surgeon and staff during the procedure.
The authors performed a retrospective analysis of a prospectively acquired database of patients undergoing LLIF with image-based navigation performed from April 2014 to July 2016 at a single institution. The medical records were reviewed, and data on clinical outcomes, cage accuracy, complications, and radiation exposure were recorded. All patients underwent a minimum 30-d clinical follow-up to assess intraoperative and short-term complications associated with their LLIF.
Sixty-three patients comprising 117 spinal levels were included in the study. There were 36 (57.1%) female and 27 (42.9%) male patients. Mean age was 62.7 yr (range 24-79 yr). A mean 1.9 (range 1-4) levels per patient were treated. Cages were placed in the anterior or middle of 115 (98.3%) disc spaces. Image-guided cage trajectory was accurate in 116/117 levels (99.1%). In a subgroup analysis of 18 patients, mean fluoroscopy time was 11.7 ± 9.7 s per level. Sixteen (25.4%) patients experienced a complication related to approach.
Use of intraoperative cone-beam computed tomography combined with spinal navigation for LLIF results in accurate and safe cage placement as well as significantly decreased surgeon and staff radiation exposure.
微创侧路腰椎椎间融合术（LLIF）传统上采用双平面透视。最近的文献表明，术中使用锥形束 CT 结合脊柱导航可以安全地用于 LLIF 的定位和 cage 放置。
评估脊柱导航在 LLIF 中使用 cage 放置的准确性和安全性，以及评估手术过程中外科医生和工作人员的辐射暴露情况。
作者对 2014 年 4 月至 2016 年 7 月在一家单机构进行的基于图像的导航下进行的 LLIF 患者的前瞻性数据库进行了回顾性分析。回顾了病历，并记录了临床结果、cage 准确性、并发症和辐射暴露的数据。所有患者均进行了至少 30 天的临床随访，以评估与他们的 LLIF 相关的术中及短期并发症。
研究纳入 63 例患者共 117 个脊柱节段。其中 36 例（57.1%）为女性，27 例（42.9%）为男性。平均年龄为 62.7 岁（范围 24-79 岁）。平均每位患者治疗 1.9 个（范围 1-4）节段。cage 放置在 115 个（98.3%）椎间盘的前或中部。117 个节段中，有 116 个（99.1%）的图像引导 cage 轨迹准确。在 18 例患者的亚组分析中，平均每个节段透视时间为 11.7±9.7 秒。16 例（25.4%）患者出现与入路相关的并发症。
术中使用锥形束 CT 结合脊柱导航进行 LLIF 可实现准确、安全的 cage 放置，并显著降低外科医生和工作人员的辐射暴露。
