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In This Article

  • Summary
  • Abstract
  • Introduction
  • Protocol
  • Representative Results
  • Discussion
  • Acknowledgements
  • Materials
  • References
  • Reprints and Permissions

Summary

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.

Abstract

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.

Introduction

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 level

Protocol

This study was approved by the ethics committee at Okayama Rosai Hospital (No. 201-3).

1. Patient examination

  1. History taking
    1. 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.
    2. Ask the patient to describe the radiating leg pain, its location, and aggravating and reliev.......

Representative Results

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).

figure-representative results-454

Discussion

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.......

Acknowledgements

This study was supported by the Okayama Spine Group.

....

Materials

NameCompanyCatalog NumberComments
Adjustable hinged operating carbon tableMizuho OSI6988A-PV-ACPOSI Axis Jackson table
CD Horizon Solera VoyagerMedtronic6.4317E+11Percutaneous pedicle screw system
Navigated Cobb elevatorMedtronicNAV2066
Navigated combo toolMedtronicNAV2068
Navigated curetteMedtronicNAV2069
Navigated high speed burMedtronicEM200NStelth
Navigated passive pointerMedtronic960-559
Navigated pedicle probeMedtronic9734680
Navigated shaverMedtronicNAV2071
NIM Eclipse systemMedtronicECLCNeuromonitouring
O-armMedtronic224ABBZX00042000Intraoperative CT
Radiolucent open spine crampMedtronic9731780
Self-retaining retractorMedtronic29B2X10008MDT151
Sovereign Spinal SystemMedtronic6.4317E+11OLIF51 cage
Spine small passive frameMedtronic9730605
Stealth station navigation system Spine 7RMedtronic9733990Navigation
U-NavLock GrayMedtronic9734590
U-NavLock GreenMedtronic9734734
U-NavLock OrangeMedtronic9734683
U-NavLock VioletMedtronic9734682

References

  1. Tawfik, S., Phan, K., Mobbs, R. J., Rao, P. J. The incidence of pars interarticularis defects in athletes. Global Spine Journal. 10 (1), 89-101 (2020).
  2. Sonne-Holm, S., Jacobsen, S., Rovsing, H. C., Monrad, H., Gebuhr, P.

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C arm freeOLIF51Percutaneous Pedicle Screw FixationSpondylosisSpondylolisthesisTLIFALIFOLIFPosterior Ligament AugmentationLateral PositionO armNIM Neuro Monitoring

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