Is bony attachment necessary for dynamic reference frame in navigation-assisted minimally invasive lumbar spine fusion surgery?

Abstract

This study aimed to compare the accuracy of navigation-assisted percutaneous pedicle screw insertions between traditional posterior superior iliac spine (PSIS) fixed and cutaneously fixed dynamic reference frame (DRF) in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF). This is a prospective randomized clinical study. Between May 2016 and Nov 2017, 100 patients who underwent MIS TLIF were randomly divided into bone fixed group (with PSIS fixed DRF) and skin fixed group (with cutaneously fixed DRF). The pedicel screws were inserted under navigational guidance using computed tomography (CT) data acquired intraoperatively with a Ziehm 3-dimensional fluoroscopy-based navigation system. Screw positions were immediately checked by a final intraoperative scan. The accuracy of screw placement was evaluated by a sophisticated computed tomography protocol. Both groups had similar patient demographics. Totally Five-hundred Twelve pedicle screws were placed in the lumbar spine. There were 2 moderate (2-4 mm) pedicle perforations in each group. The accuracy showed no significant difference between bone fixed and skin fixed DRF. There were no significant procedure-related complications. The skin fixed DRF provides similar accuracy in pedicle screw insertions with bone fixed DRF using intraoperative 3D image guided navigation in MIS TLIF. Skin fixed DRF not only serves as an alternative method but also saves a separate incision wound for bony attachment.

Postoperative spinal orthosis may not be necessary for minimally invasive lumbar spine fusion surgery: a prospective randomized controlled trial

“…Rod was then placed and fixed with nuts after rechecking the position. Microscopic decompression and transforaminal lumbar interbody fusion was then performed under the incision for pedicle screws with cage, demineralized bone matrix(OsteoSelect AQ3 DBM Putty, Bacterin International Inc., Belgrade, MT), and autologous bone graft [14,15]. All surgeries were performed by 1 senior spinal surgeon.…”

Surface Navigation and the Influence of Navigation on MIS Surgery

“…A study by Lin et al in 2019 demonstrated similarly high accuracy, in which approximately 96% of both skin-based versus bone-anchored navigation guided pedicle screws were accurately placed during MIS-TLIF. 15 A study by Vaishnav et al examined the use of surface-based ION in 92 lumbar microdiscectomies, 65 laminectomies, and 75 MIS-TLIFs. 13 A median time of 22-24 minutes was required for ION setup and image acquisition.…”

“…A study by Lin et al in 2019 demonstrated similarly high accuracy, in which approximately 96% of both skin-based versus bone-anchored navigation guided pedicle screws were accurately placed during MIS-TLIF. 15 …”

Pearls and pitfalls of posterior superior iliac spine reference frame placement for spinal navigation: cadaveric series

“…For lumbosacral surgical procedures, the PSIS is the preferred location for the reference frame, as this location avoids obstruction of instrumentation trajectory, prevents blocking the visualization of the surgical corridor, evades streak artifact, and provides enhanced stability of the reference frame. 6,10 Lessons Combining anatomical landmarks, palpation, and radiographic techniques, the PSIS can be easily accessed for reference frame placement with solid bony purchase and avoidance of the surgical corridor. This is a well-tolerated technique that can be performed safely and efficiently.…”

“…For lumbosacral surgical procedures, the PSIS is the preferred location for the reference frame, as this location avoids obstruction of instrumentation trajectory, prevents blocking the visualization of the surgical corridor, evades streak artifact, and provides enhanced stability of the reference frame. 6 , 10 …”