Simultaneous single-position lateral interbody fusion and percutaneous pedicle screw fixation using O-arm-based navigation reduces the occupancy time of the operating room

• Published in: European Spine Journal Vol. 29; no. 6; pp. 1277 - 1286
• Main Authors: Ouchida, Jun, Kanemura, Tokumi, Satake, Kotaro, Nakashima, Hiroaki, Ishikawa, Yoshimoto, Imagama, Shiro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Science and Business Media LLC 01.06.2020; Springer Berlin Heidelberg; Springer Nature B.V
• Subjects: Bone implants; Decompression; Imaging, Three-Dimensional; Lumbar Vertebrae; Medicine; Medicine & Public Health; Neurosurgery; Operating Rooms; Original Article; Pedicle Screws; Radiography; Spinal Fusion; Spondylolisthesis; Surgery; Surgery, Computer-Assisted; Surgical Orthopedics; Surgical outcomes; Tomography, X-Ray Computed; Pedicle screw; Percutaneous; Lateral lumbar interbody fusion; Indirect decompression; Single position
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-020-06388-6

Purpose Lateral interbody fusion and posterior percutaneous pedicle screw (LIF-PPS) fixation has been performed in two-stage positioning. The aim of this study was to investigate the surgical outcomes of simultaneous single-position LIF-PPS fixation using O-arm-based navigation. Methods Overall, 102 consecutive subjects underwent indirect decompression surgery for spondylolisthesis with LIF-PPS fixation. Fifty-one subjects underwent surgery with repositioning, and 51 in the right lateral decubitus position. We compared these two groups in terms of the surgery time, occupancy time in the operating room, intraoperative blood loss, Japanese Orthopaedic Association (JOA) score, local lordosis acquisition in postoperative radiographs, and accuracy of screw insertion using postoperative CT scans. Results In the single-position group, surgery time, occupancy time of the operating room, and estimated blood loss were 93.3 ± 19.3 min (vs. the repositioning group: 121.0 ± 37.1 min; p  <  0.001), 176.3 ± 36.4 min (vs. 272.4 ± 42.7 min; p  < 0.001), and 93.4 ± 78.8 ml (vs. 40.9 ± 28.7 ml; p  < 0.001), respectively. The JOA scores (pre-/postoperative) were 15.1 ± 3.0/24.4 ± 2.8 ( p  < 0.001) for the single-position group and 15.1 ± 4.0/24.8 ± 3.0 ( p  < 0.001) for the repositioning group. The rate of misplacement was 1.8% versus 4.0%, respectively ( p  = 0.267), and the lordosis acquisition was 4.2° ± 4.1° versus 4.4° ± 3.2°, respectively ( p  = 0.516). Conclusions Single-position surgery exhibited comparable clinical outcomes and local lordosis acquisition with conventional repositioning LIF-PPS fixation. This single-position minimally invasive technique reduces the occupancy time of the operating room and workforce requirements. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.