Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 14;16(4):585-594.
doi: 10.14444/8294. Online ahead of print.

Multimodal Applications of 3D-Navigation in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: Impacts on Precision, Accuracy, Complications, and Radiation Exposure

Arvind G Kulkarni  1 , Pritem A Rajamani  2 , Sandeep Tapashetti  2 , Tushar Sathish Kunder  2
Affiliations

Multimodal Applications of 3D-Navigation in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: Impacts on Precision, Accuracy, Complications, and Radiation Exposure

Arvind G Kulkarni et al. Int J Spine Surg. .

Abstract

Background: Three-dimensional (3D)-navigation in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is an evolving procedure. It is used not only for its accuracy of pedicle screw fixation but also for other major steps in transforaminal lumbar interbody fusion. Multimodal outcomes of this procedure are very limited in the literature. The purpose of this study was to examine the application of 3D-navigation in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

Methods: Patients who underwent single-level MI-TLIF using 3D-navigation between January 2017 and July 2019 were evaluated for navigation setting time, radiation exposure, volume of nucleus pulposus excised, cage placement, accuracy of pedicle screw placement, and cranial facet-joint violation.

Results: One hundred and two patients with a mean age of 60.2 years met the inclusion criteria. The mean presetting time of navigation was 46.65 ± 9.45 minutes. Radiation exposure, fluoroscopy use, and fluoroscopy time were 15.54 ± 0.65 mGy, 4.43 ± 0.87 Gy.cm², and 97.6 ± 11.67 seconds, respectively. The mean amount of nucleus pulposus excised from all quadrants was quantified. The cage was centrally placed in 87 patients, with 95.4% showing a Grade 0 pedicle breach and 94.6% showing Grade 0 cranial facet-joint violation.

Conclusion: Registration and setting up 3D-navigation takes additional time. The amount of exposure to the patient is much less compared to routine computed tomography, and, importantly, the operating team is protected from radiation. Navigated MI-TLIF has high rates of accuracy with regard to placement of percutaneous pedicle screws and cages with the added advantage of protection of the cranial facet-joint.

Keywords: 3D-navigation; lumbar spine; minimally invasive spine surgery; spinal navigation; transforaminal lumbar interbody fusion.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Contralateral posterior quadrant where yellow margin indicates intact annulus fibrosis with remnant nucleus pulposus and blue navigation probe restricts beyond the annulus fibrosis.
Figure 2
Figure 2
Contralateral anterior area where nucleus pulposus is removed and rechecked with the navigation array probe.
Figure 3
Figure 3
Overall removal of the nucleus pulposus area with intact marginal annulus fibrosis.
Figure 4
Figure 4
Final position of all the pedicle screws in the navigation screen.
Figure 5
Figure 5
Percentage of disc space removed for cage placement by quadrant.
Figure 6
Figure 6
Position of cage placement.
Figure 7
Figure 7
Assessment of cage placement with navigated array probe.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine (Phila Pa 1976). 2010;35(26 Suppl):S294-301. 10.1097/BRS.0b013e3182022ddc - DOI - PubMed
    1. Scheufler KM, Dohmen H, Vougioukas VI. Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery. 2007;60(4 Suppl 2):203–212. 10.1227/01.NEU.0000255388.03088.B7 - DOI - PubMed
    1. Holly LT, Schwender JD, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus. 2006;20(3):3–7. 10.3171/foc.2006.20.3.7 - DOI - PubMed
    1. Mendelsohn D, Strelzow J, Dea N, et al. . Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation. Spine J. 2016;16(3):343–354. 10.1016/j.spinee.2015.11.020 - DOI - PubMed
    1. Mason A, Paulsen R, Babuska JM, et al. . The accuracy of pedicle screw placement using intraoperative image guidance systems. J Neurosurg Spine. 2014;20(2):196–203. 10.3171/2013.11.SPINE13413 - DOI - PubMed