scholarly journals Minimally invasive transforaminal lumbar interbody fusion with percutaneous navigated guidewireless lumbosacral pedicle screw fixation

2016 ◽  
Vol 41 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
Kevin S. Chen ◽  
Paul Park
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Pedicle Screw Fixation ◽  
Screw Placement ◽  
Foraminal Stenosis ◽  
Invasive Approach ◽  
Percutaneous Pedicle Screw ◽  
Key Steps

This video details the minimally invasive approach for treatment of a symptomatic Grade II lytic spondylolisthesis with high-grade foraminal stenosis. In this procedure, the use of a navigated, guidewireless technique for percutaneous pedicle screw placement at the lumbosacral junction is highlighted following initial decompression and transforaminal interbody fusion. Key steps of the procedure are delineated that include positioning, exposure, technique for interbody fusion, intraoperative image acquisition, and use of a concise 2-step process for navigated screw placement without using guidewires.The video can be found here: https://youtu.be/2u6H4Pc_8To.

Minimally Invasive Single-Position Lateral Interbody Fusion With Robotic Bilateral Percutaneous Pedicle Screw Fixation: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. E121-E121 ◽  
Author(s):  
Corey T Walker ◽  
Jakub Godzik ◽  
David S Xu ◽  
Nicholas Theodore ◽  
Juan S Uribe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Screw Placement ◽  
Lateral Interbody Fusion ◽  
Percutaneous Pedicle Screw ◽  
Percutaneous Pedicle Screw Fixation ◽  
Lateral Interbody

Abstract Lateral interbody fusion has distinct advantages over traditional posterior approaches. When adjunctive percutaneous pedicle screw fixation is required, placement from the lateral decubitus position theoretically increases safety and improves operative efficiency by obviating the need for repositioning. However, safe cannulation of the contralateral, down-side pedicles remains technically challenging and often prohibitive. In this video, we present the case of a 59-yr-old man with refractory back pain and bilateral lower extremity radiculopathy that was worse on the left than right side. The patient provided written informed consent before undergoing treatment. We performed minimally invasive single-position lateral interbody fusion with robotic (ExcelsiusGPS, Globus Medical Inc, Audubon, Pennsylvania) bilateral percutaneous pedicle screw fixation for the treatment of asymmetric disc degeneration, dynamic instability, and left paracentral disc herniation with corresponding stenosis at the L3-4 level. A left-sided minimally invasive transpsoas lateral interbody graft was placed with fluoroscopic guidance. Without changing the position of the patient or breaking the sterile field, an intraoperative cone-beam computed tomography image was obtained for navigational screw placement with stereotactic trackers in the iliac spine. Screw trajectories were planned using the robotic navigation software and were placed percutaneously in the bilateral L3 and L4 pedicles using the robotic arm. Concomitant lateral fluoroscopy may be used if desired to ensure the fidelity of the robotic guidance. The patient recovered well postoperatively and was discharged home within 36 h, without complication. Single-position lateral interbody fusion and percutaneous pedicle screw fixation can be accomplished using robotic-assisted navigation and pedicle screw placement. Used with permission from Barrow Neurological Institute.

Minimally invasive unilateral approach for bilateral decompression of spinal stenosis and modified transforaminal lumbar interbody fusion for degenerative spondylolisthesis

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video4 ◽  
Author(s):  
Kevin S. Chen ◽  
Khoi D. Than ◽  
Frank LaMarca ◽  
Paul Park
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spinal Stenosis ◽  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Invasive Approach ◽  
Unilateral Approach ◽  
Percutaneous Pedicle Screw

This video describes a minimally invasive approach for treatment of symptomatic grade I spondylolisthesis and high-grade spinal stenosis. In this procedure, a unilateral approach for bilateral decompression is utilized in conjunction with a modified transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation. The key steps in the procedure are outlined, and include positioning, fluoroscopic positioning/guidance, exposure with tubular retractor system, technique for ipsilateral and contra-lateral decompression, disc space preparation and interbody grafting, percutaneous pedicle screw and rod placement, and closure.The video can be found here: http://youtu.be/QTymO4Cu4B0.

Incidence of and risk factors for superior facet violation in minimally invasive versus open pedicle screw placement during transforaminal lumbar interbody fusion: a comparative analysis

2013 ◽  
Vol 18 (4) ◽  
pp. 356-361 ◽  
Author(s):  
Darryl Lau ◽  
Samuel W. Terman ◽  
Rakesh Patel ◽  
Frank La Marca ◽  
Paul Park
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw

Object A reported risk factor for adjacent-segment disease is injury to the superior facet joint from pedicle screw placement. Given that the facet joint is not typically visualized during percutaneous pedicle screw insertion, there is a concern for increased facet violation (FV) in minimally invasive fusion procedures. The purpose of this study was to analyze and compare the incidence of FV among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open transforaminal lumbar interbody fusion (TLIF). The impact of O-arm navigation compared with traditional fluoroscopy on FV in MITLIF is also assessed, as are risk factors for FV. Methods The authors identified a consecutive population of patients who underwent MITLIF with percutaneous pedicle screw placement, as well as a matched cohort of patients who underwent open TLIF. Postoperative CT imaging was assessed to determine intraarticular FV due to pedicle screw placement. Patients were stratified into minimally invasive and open TLIF groups. Within the MITLIF group, the authors performed a subanalysis of image guidance methods used in cases of FV. Two-tailed Student t-test, ANOVA, chi-square testing, and logistic regression were used for statistical analysis. Results A total of 282 patients were identified, with a total of 564 superior pedicle screw placements. The MITLIF group consisted of 142 patients with 284 screw insertions. The open TLIF group consisted of 140 patients with 280 screw insertions. Overall, 21 (7.4%) of 282 patients experienced FV. A total of 21 screws violated a facet joint for a screw-based FV rate of 3.7% (21 of 564 screws). There were no significant differences between the MITLIF and open TLIF groups in the percentage of patients with FV (6.3% vs 8.6%) and or the percentage of screws with FV (3.2% vs 4.3%) (p = 0.475 and p = 0.484, respectively). Further stratifying the MI group into O-arm navigation and fluoroscopic guidance subgroups, the patient-based rates of FV were 10.8% (4 of 37 patients) and 4.8% (5 of 105 patients), respectively, and the screw-based rates of FV were 5.4% (4 of 74 screws) and 2.4% (5 of 210 screws), respectively. There was no significant difference between the subgroups with respect to patient-based or screw-based FV rates (p = 0.375 and p = 0.442, respectively). The O-arm group had a significantly higher body mass index (BMI) (p = 0.021). BMI greater than 29.9 was independently associated with higher FV (OR 2.36, 95% CI 1.65–8.53, p = 0.039). Conclusions The findings suggest that minimally invasive pedicle screw placement is not associated with higher rates of FV. Overall violation rates were similar in MITLIF and open TLIF. Higher BMI, however, was a risk factor for increased FV. The use of O-arm fluoroscopy with computer-assisted guidance did not significantly decrease the rate of FV.

scholarly journals Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement Under Regional Anaesthesia: A Comparative Cohort Study

2021 ◽  
Author(s):  
Shangju Gao ◽  
Jingchao Wei ◽  
Wenyi Li ◽  
Long Zhang ◽  
Can Cao ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
General Anaesthesia ◽  
Pedicle Screw ◽  
Regional Anaesthesia ◽  
Interbody Fusion ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Percutaneous Pedicle Screw

Abstract Background: Robot-assisted pedicle screw placement is usually performed under general anaesthesia to keep the body still. The aim of this study was to compare the accuracy of the robot-assisted technique under regional anaesthesia with conventional fluoroscopy-guided percutaneous pedicle screw placement under general anaesthesia in minimally invasive lumbar fusion surgery.Methods: Patients who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) from December 2017 to February 2020 in a single centre were included. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anaesthesia (group RE-RO) and fluoroscopy-guided under general anaesthesia (group GE-FLU) groups. The primary outcome measures were screw accuracy and the incidence of facet joint violation (FJV). Secondary outcome measures included X-ray exposure and intraoperative adverse events.Results: Eighteen patients were included in group RE-RO, and 23 patients were included in group GE-FLU. The percentages of clinically acceptable screws (Gertzbein and Robbins grades A and B) were 94.4% and 91.5%, respectively. There was no significant difference in the percentages of clinically acceptable screws (p=0.44) or overall Gertzbein and Robbins screw accuracy grades (p=0.35). Only the top screws were included in the analysis of FJVs. The percentages of FJV (Babu grades 1, 2 and 3) were 5.6% and 28.3%, respectively. This difference was statistically significant (p=0.01). Overall, the FJV grades in group RE-RO were significantly better than those in group GE-FLU (p=0.009). The mean fluoroscopy time for each screw in group RE-RO was significantly shorter than that in group GE-FLU (group RE-RO, 5.4±1.9 seconds, group GE-FLU, 6.8±2.0 seconds; P=0.03). The intraoperative adverse events included 1 case of registration failure and 1 case of guide-wire dislodgment in group RE-RO as well as 2 cases of screw misplacement in group GE-FLU. No complications related to anaesthesia were observed.Conclusion: Robot-assisted pedicle screw placement under regional anaesthesia can be performed effectively and safely. The accuracy is comparable to the conventional technique. Moreover, this technique has the advantage of fewer FJVs and a lower radiation time.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: 2-Dimensional Surgical Video

2019 ◽  
Vol 17 (2) ◽  
pp. E53-E53
Author(s):  
Joseph H McMordie ◽  
Eric X Chen ◽  
Landon D Ehlers ◽  
Christopher C Gillis
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Patient Positioning ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Intraoperative Navigation ◽  
Radiographic Evaluation ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Invasive Approach ◽  
Percutaneous Pedicle Screw

Abstract This operative video is a detailed look at minimally invasive transforaminal lumbar interbody fusion. We provide a step-by-step guide with appropriate narration and operative video to enhance the educational experience. We review clinical and radiographic evaluation, patient positioning, intraoperative navigation, localization, percutaneous pedicle screw placement, minimally invasive approach, disc space preparation, placement of interbody device, and closure. By presenting up-to-date minimally invasive and intraoperative navigation techniques, this video provides educational benefit to all neurosurgeons regardless of training level.

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