Neurosurgery Atlantic Brain and Spine Wilmington, North Carolina, United States
Introduction: Lateral single-position pedicle screw fixation (L-PSF) after lateral interbody fusion (LIBF) allows for pedicle screw placement without an additional positioning of the patient. Although this technique shows promise to decrease operating room time, standard fluoroscopy in the lateral position presents challenges to ergonomics and difficulty operating with the AP image. For this reason, navigation and robotics techniques have been described. Any time savings afforded by the lack of repositioning is lost with the need for registration and the time that these technologies add, alongside substantial radiation exposure to the patient. Herein we describe the use of fluoroscopic tracking as an alternative technique to enable L-PSF.
Methods: Every LIBF (NuVasive, San Diego CA) performed by a single surgeon over a 2-month period was included to study efficacy of screw placement in the lateral position. All cases were initiated with the anterolateral (for L5S1), lateral (for L2-L5), or combined approaches. Screw placement was commenced without repositioning, often as the initial approach incision was being closed. Fluoroscopic tracking (TrackX, Hillsborough NC) was used for instrument tracking. Time, number of X-rays, and radiation for each step were recorded in excel and analyzed using Matlab.
Results: 50 screws from 10 consecutive cases by a single surgeon during a 2-month period (November-December 2021). Anatomy registration and incision marking averaged < 3 minutes and 2.2mGy. Pedicle cannulation averaged < 2 mins/pedicle (1:45, 1:09-5:07) with 7 x-rays taken prior to confirmation of wire placement. The fixation portion of the cases were completed (screws, rods, and facet fusions) & ready for closure in 15:59. In total, registration to beginning of closure took just over 30 minutes (32:24 +\- 15:11). The entire posterior procedure averaged 12.8mGy of total radiation per case, just over 2mGy/screw (2.2 +\- 3.69mGy). No posterior position screws were placed after LIBF during this period. No screw was abandoned. There were no symptomatic malpositioned screws.
Conclusion : L-PSF can be performed safely and efficiently after LIBF. X-ray tracking using TrackX allows for LPS in 30 minutes with only 2mGy/screw.
How to Improve Patient Care: X-ray tracking affords the surgeon OR efficiency by not repositioning while exposing the patient, staff, and surgeon to a minimal amount of radiation.
