Fully Navigated Single-Position Prone Lateral Lumbar Interbody Fusion: A Detailed Technical Report and Description of 15 Cases.

Abstract

Background: Navigation increases the precision and safety of pedicle screw placement and has been used to place interbody cages for lateral lumbar interbody fusion. Single-position surgery shortens its duration and that of anesthesia. The aim of this study was the feasibility of simultaneous cage and screw placement in a single prone position using intraoperative navigation without the need for additional fluoroscopy and a detailed technical description of this procedure.

Methods: We retrospectively analyzed 15 patients who underwent simultaneous navigated lateral lumbar interbody fusion and posterior instrumentation in a single prone position. A detailed technical description of the procedure is provided. Surgery duration, blood loss, complications, and radiographic parameters were recorded.

Results: A total of 24 cages were placed in 15 patients. The mean time taken for cage placement was 21 ± 6.70 minutes, and there were no major complications. Mean surgery duration and blood loss per case, including posterior instrumentation, were 263 ± 94 minutes and 315 ± 143 mL, respectively. There were significant improvements in pre- to postoperative Oswestry Disability Index scores (51.38 ± 15.93 vs 32.81 ± 17.18, P < 0.001) and segmental lordosis (3.26° ± 8.97° vs 13.09° ± 15.25°, P < 0.001).

Conclusion: The present study's results showed the feasibility of lateral lumbar interbody fusion using simultaneous posterior pedicle screw instrumentation and intraoperative navigation in a single prone position.

Clinical relevance: Navigated lateral lumbar interbody fusion and posterior instrumentation in a single prone position possibly reduces operating time and blood loss and reduces exposure of operation room personnel to radiation.

Level of evidence: 4: