Name: c-arm-free simultaneous olif51 and percutaneous pedicle screw fixation in a single lateral position
Uploaded: 2022-09-16T13:00:00
Description: Watch this Scientific Journal Video about C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position at JoVE.com

This study was supported by the Okayama Spine Group.

This study was approved by the ethics committee at Okayama Rosai Hospital (No. 201-3).
1. Patient examination
<ol>
	<li>History taking
	<ol>
		<li>Evaluate a patient with a suspected herniated disc or stenosis by taking their history. Usually, the patient presents with a history of prodromal low back pain. The patient may correlate their symptoms with an episode of trauma.</li>
		<li>Ask the patient to describe the radiating leg pain, its location, and aggravating and reliev...

<ol>
	<li>Tawfik, S., Phan, K., Mobbs, R. J., Rao, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+incidence+of+pars+interarticularis+defects+in+athletes.">The incidence of pars interarticularis defects in athletes.</a> Global Spine Journal. 10 (1), 89-101 (2020).</li><li>Sonne-Holm, S., Jacobsen, S., Rovsing, H. C., Monrad, H., Gebuhr, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lumbar+spondylolysis:+A+life+long+dynamic+condition?+A+cross+sectional+survey+of+4.151+adults.">Lumbar spondylolysis: A life long dynamic condition? A cross sectional survey of 4.151 adults.</a> European Spine Journal. 16 (6), 821-828 (2007).</li><li>McAfee, P. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+indications+for+interbody+fusion+cages+in+the+treatment+of+spondylolisthesis:+Analysis+of+120+cases.">The indications for interbody fusion cages in the treatment of spondylolisthesis: Analysis of 120 cases.</a> Spine. 30 (6), 60-65 (2005).</li><li>Parajon, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimally+invasive+transforaminal+lumbar+interbody+fusion:+Meta-analysis+of+the+fusion+rates.+What+is+the+optimal+graft+material.">Minimally invasive transforaminal lumbar interbody fusion: Meta-analysis of the fusion rates. What is the optimal graft material.</a> Neurosurgery. 81 (6), 958-971 (2017).</li><li>Lowe, T. G., Tahernia, A. D., O'Brien, M. F., Smith, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Unilateral+transforaminal+posterior+lumbar+interbody+fusion+(TLIF):+Indications,+technique,+and+2-year+results.">Unilateral transforaminal posterior lumbar interbody fusion (TLIF): Indications, technique, and 2-year results.</a> Journal of Spinal Disorders and Techniques. 15 (1), 31-38 (2002).</li><li>Mayer, H. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+microsurgical+technique+for+minimally+invasive+anterior+lumbar+interbody+fusion.">A new microsurgical technique for minimally invasive anterior lumbar interbody fusion.</a> Spine. 22 (6), 691-699 (1997).</li><li>Hodgson, A. R., Stock, F. E., Fang, H. S. Y., Ong, G. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anterior+spinal+fusion+the+operative+approach+and+pathological+findings+in+412+patients+with+Pott's+disease+of+the+spine.">Anterior spinal fusion the operative approach and pathological findings in 412 patients with Pott's disease of the spine.</a> The British Journal of Surgery. 48, 172-178 (1960).</li><li>Woods, K., Billy, J. B., Hynes, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Technical+description+of+oblique+lateral+interbody+fusion+at+L1-L5+(OLIF25)+and+at+L5-S1+(OLIF51)+and+evaluation+of+complication+and+fusion+rates.">Technical description of oblique lateral interbody fusion at L1-L5 (OLIF25) and at L5-S1 (OLIF51) and evaluation of complication and fusion rates.</a> The Spine Journal. 17 (4), 545-553 (2017).</li><li>Tan, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+simultaneous+single-position+oblique+lumbar+interbody+fusion+and+percutaneous+pedicle+screw+fixation+with+posterior+lumbar+interbody+fusion+using+O-arm+navigated+technique+for+lumbar+degenerative+diseases.">Comparison of simultaneous single-position oblique lumbar interbody fusion and percutaneous pedicle screw fixation with posterior lumbar interbody fusion using O-arm navigated technique for lumbar degenerative diseases.</a> Journal of Clinical Medicine. 10 (21), 4938 (2021).</li><li>Phillips, F. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adult+degenerative+scoliosis+treated+with+XLIF:+Clinical+and+radiographical+results+of+a+prospective+multicenter+study+with+24-month+follow-up.">Adult degenerative scoliosis treated with XLIF: Clinical and radiographical results of a prospective multicenter study with 24-month follow-up.</a> Spine. 38 (21), 1853-1861 (2013).</li><li>Davis, T. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retroperitoneal+oblique+corridor+to+the+L2-S1+intervertebral+discs+in+the+lateral+position:+An+anatomic+study.">Retroperitoneal oblique corridor to the L2-S1 intervertebral discs in the lateral position: An anatomic study.</a> Journal of Neurosurgery: Spine. 21 (5), 78 (2014).</li><li>Houten, J. K., Alexandre, L. C., Nasser, R., Wollowick, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nerve+injury+during+the+transpsoas+approach+for+lumbar+fusion.">Nerve injury during the transpsoas approach for lumbar fusion.</a> Journal of Neurosurgery: Spine. 15 (3), 280-284 (2011).</li><li>Tanaka, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=C-arm+free+simultaneous+OLIF51+and+percutaneous+pedicle+screw+fixation+in+a+single+lateral+position:+A+technical+note.">C-arm free simultaneous OLIF51 and percutaneous pedicle screw fixation in a single lateral position: A technical note.</a> Interdisciplinary Neurosurgery. 27, 101428 (2022).</li><li>Hadelsberg, U. P., Harel, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hazards+of+ionizing+radiation+and+its+impact+on+spine+surgery.">Hazards of ionizing radiation and its impact on spine surgery.</a> World Neurosurgery. 92, 353-359 (2016).</li><li>Kim, T. T., Drazin, D., Shweikeh, F., Pashman, R., Johnson, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+and+radiographic+outcomes+of+minimally+invasive+percutaneous+pedicle+screw+placement+with+intraoperative+CT+(O-arm)+image+guidance+navigation.">Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation.</a> Neurosurgical Focus. 36 (3), 1 (2014).</li><li>Kakarla, U. K., Little, A. S., Chang, S. W., Sonntag, V. K., Theodore, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Placement+of+percutaneous+thoracic+pedicle+screws+using+neuronavigation.">Placement of percutaneous thoracic pedicle screws using neuronavigation.</a> World Neurosurgery. 74 (6), 606-610 (2010).</li><li>Nagamatsu, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+3D+lumbosacral+vascular+anatomy+for+OLIF51+by+non-enhanced+MRI+and+CT+medical+image+fusion+technique.">Assessment of 3D lumbosacral vascular anatomy for OLIF51 by non-enhanced MRI and CT medical image fusion technique.</a> Diagnostics. 11 (10), 1744 (2021).</li><li>Tanaka, M., Fujiwara, Y., Uotani, K., Maste, P., Yamauchi, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=C-arm-free+circumferential+minimally+invasive+surgery+for+adult+spinal+deformity:+Technical+note.">C-arm-free circumferential minimally invasive surgery for adult spinal deformity: Technical note.</a> World Neurosurgery. 143, 235-246 (2020).</li></ol>

Recently, the lateral lumbar approach for interbody fusion has been gaining popularity due to its minimal invasiveness9. Among these approaches, the direct lateral psoas splitting approach has several disadvantages, such as lumbar nerve plexus injury and psoas muscle weakness10. To reduce these complications, prepsoas or OLIF was introduced by Davis et al. in 201411. However, it is difficult to operate at the L5-S1 disc due to its anatomical features...

Spondylosis is regarded as a stress fracture1 and occurs in about 5% of the young adult population2. The most common level of occurrence is at the L5 level due to the unique shearing force applied at the L5-S1 area. The main symptoms of spondylosis and spondylolisthesis are low back pain, leg pain, and numbness. If conservative treatment proves ineffective, surgical treatment is recommended3. Transforaminal lumbar interbody fusion (TLIF) is an effective and established technique4, but the nonunion rate of this procedure is relatively higher at the L5-S1 level5. Furthermore, with TLIF, it is difficult to create adequate lordosis compared to oblique lumbar interbody fusion (OLIF) or anterior lumbar interbody fusion (ALIF)6.
Indirect decompressions such as ALIF or OLIF are currently common methods for treating lumbar stenosis7. However, the conventional ALIF technique causes a large amount of muscle damage. Oblique lateral interbody fusion at the L5-S1 level (OLIF51) was first reported in 20178. Posterior instrument augmentation is usually necessary to ensure solid fusion, but the conventional OLIF technique uses a C-arm, and the patient position is changed from lateral to prone. To overcome these problems, we report herein a novel technique of C-arm-free simultaneous OLIF51 and percutaneous pedicle screws (PPSs) in a single lateral position. 
We introduce the case of a 75-year-old woman with symptomatic L5 spondylolisthesis (grade 2).

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Adjustable hinged operating carbon table</td>
			<td>Mizuho OSI</td>
			<td>6988A-PV-ACP</td>
			<td>OSI Axis Jackson table</td>
		</tr>
		<tr>
			<td>CD Horizon Solera Voyager</td>
			<td>Medtronic</td>
			<td>6.4317E+11</td>
			<td>Percutaneous pedicle screw system</td>
		</tr>
		<tr>
			<td>Navigated Cobb elevator</td>
			<td>Medtronic</td>
			<td>NAV2066</td>
			<td></td>
		</tr>
		<tr>
			<td>Navigated combo tool</td>
			<td>Medtronic</td>
			<td>NAV2068</td>
			<td></td>
		</tr>
		<tr>
			<td>Navigated curette</td>
			<td>Medtronic</td>
			<td>NAV2069</td>
			<td></td>
		</tr>
		<tr>
			<td>Navigated high speed bur</td>
			<td>Medtronic</td>
			<td>EM200N</td>
			<td>Stelth</td>
		</tr>
		<tr>
			<td>Navigated passive pointer</td>
			<td>Medtronic</td>
			<td>960-559</td>
			<td></td>
		</tr>
		<tr>
			<td>Navigated pedicle probe</td>
			<td>Medtronic</td>
			<td>9734680</td>
			<td></td>
		</tr>
		<tr>
			<td>Navigated shaver</td>
			<td>Medtronic</td>
			<td>NAV2071</td>
			<td></td>
		</tr>
		<tr>
			<td>NIM Eclipse system</td>
			<td>Medtronic</td>
			<td>ECLC</td>
			<td>Neuromonitouring</td>
		</tr>
		<tr>
			<td>O-arm</td>
			<td>Medtronic</td>
			<td>224ABBZX00042000</td>
			<td>Intraoperative CT</td>
		</tr>
		<tr>
			<td>Radiolucent open spine cramp</td>
			<td>Medtronic</td>
			<td>9731780</td>
			<td></td>
		</tr>
		<tr>
			<td>Self-retaining retractor</td>
			<td>Medtronic</td>
			<td>29B2X10008MDT151</td>
			<td></td>
		</tr>
		<tr>
			<td>Sovereign Spinal System</td>
			<td>Medtronic</td>
			<td>6.4317E+11</td>
			<td>OLIF51 cage</td>
		</tr>
		<tr>
			<td>Spine small passive frame</td>
			<td>Medtronic</td>
			<td>9730605</td>
			<td></td>
		</tr>
		<tr>
			<td>Stealth station navigation system Spine 7R</td>
			<td>Medtronic</td>
			<td>9733990</td>
			<td>Navigation</td>
		</tr>
		<tr>
			<td>U-NavLock Gray</td>
			<td>Medtronic</td>
			<td>9734590</td>
			<td></td>
		</tr>
		<tr>
			<td>U-NavLock Green</td>
			<td>Medtronic</td>
			<td>9734734</td>
			<td></td>
		</tr>
		<tr>
			<td>U-NavLock Orange</td>
			<td>Medtronic</td>
			<td>9734683</td>
			<td></td>
		</tr>
		<tr>
			<td>U-NavLock Violet</td>
			<td>Medtronic</td>
			<td>9734682</td>
			<td></td>
		</tr>
	</tbody>
</table>

c-arm-free simultaneous olif51 and percutaneous pedicle screw fixation in a single lateral position

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 level (OLIF51) is technically difficult because of the anatomical structures. We present a novel simultaneous technique of OLIF51 with percutaneous pedicle screw fixation without fluoroscopy. The patient is placed in a right lateral decubitus position. A percutaneous reference pin is inserted into the right sacroiliac joint. An O-arm scan is performed, and 3D reconstructed images are transmitted to the spinal navigation system. A 4 cm oblique skin incision is made under navigation guidance along the pelvis. The internal/external and transverse abdominal muscles are divided along the muscle fibers, protecting the iliohypogastric and ilioinguinal nerves. Using a retroperitoneal approach, the left common iliac vessels are identified. Special muscle retractors with illumination are used to expose the L5-S1 intervertebral disc. After disc preparation with navigated instruments, the disc space is distracted with navigated trials. Autogenous bone and demineralized bone material are then inserted into the cage hole. The OLIF51 cage is inserted into the disc space with the help of a mallet. Simultaneously, percutaneous pedicle screws are inserted by another surgeon without changing the lateral decubitus position of the patient.
In conclusion, C-arm-free OLIF51 and simultaneous percutaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This novel technique reduces surgical time and radiation hazards.

Fourteen cases (average age: 71.5 years) were treated using this new technique. They were compared to 40 cases (average age: 74.0 years) of L5-S1 TLIF. L5-S1 lordosis angle and disc height were measured in both groups. The OLIF51 group obtained a better L5-S1 lordosis than the TLIF 51 group (Figure 15).
<img alt="Figure 15" class="xfigimg" src="/files/ftp_upload/63572/63572fig15.jpg" /> 
<stron...

Watch this Scientific Journal Video about C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position at JoVE.com

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position

C-arm-free oblique lumbar interbody fusion at the L5-S1 level (OLIF51) and simultaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This technique does not expose the surgeon or operating staff to radiation hazards.

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 ...

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