Radiation Dose Reduction and Surgical Efficiency Improvement in Endoscopic Transforaminal Lumbar Interbody Fusion Assisted by Intraoperative O-arm Navigation: A Retrospective Observational Study

Abstract

Objective: Endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) has gained increasing popularity among spine surgeons. However, with the use of fluoroscopy, intraoperative radiation exposure remains a major concern. Here, we aim to introduce Endo-TLIF assisted by O-arm-based navigation and compare the results between O-arm navigation and fluoroscopy groups.

Methods: Sixty-four patients were retrospectively analyzed from May 2019 to September 2020; the nonnavigation group comprised 34 patients, and the navigation group comprised 30 patients. Data on radiation dose, blood loss, postoperative drains, surgery time, complications, and length of hospital stay (LOS) were collected. Clinical outcomes were evaluated from postoperative data such as fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS). Radiation dose and surgery time were selected as primary outcomes; the others were second outcomes.

Results: All patients were followed up for at least 12 months. No significant differences were detected in intraoperative hemorrhage, postoperative drains, hospital LOS, or complications between the 2 groups. The radiation dose was significantly lower in the navigation group compared with the nonnavigation group. The time of cannula placement and pedicle screw fixation was significantly reduced in the navigation group. No significant differences were detected between the clinical outcomes in the 2 groups (VAS and ODI scores).

Conclusion: The present study demonstrates that O-arm-assisted Endo-TLIF is efficient and safe. Compared with fluoroscopy, O-arm navigation could reduce the radiation exposure and surgical time in Endo-TLIF surgery, with similar clinical outcomes. However, the higher doses exposed to patients remains a negative effect of this technology.

Keywords: Endo-TLIF surgery; Fluoroscopy; O-arm device; Percutaneous pathway; Radiation exposure; Surgery time.

Fig. 1.

(A) The percutaneous iliac pin with attached reference array is fixed in place. (B) The O-arm device is in place and prepared for image capture.

Fig. 2.

(A) Image of a navigated screwdriver with an attached tracking array, and (B) it was registered intraoperatively. (C, D) The track of the Access Tracker was visible in real time and the surgeon could make appropriate adjustments.

Fig. 3.

(A, B) The navigated trocar-like puncture probe was used during foraminoplasty. (C) The entire puncture trajectory was designed and accurately assisted by navigation. (D) The depth of the processed intervertebral space was evaluated by the Access Tracker.