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Application of electromagnetic navigation in endoscopic transforaminal lumbar interbody fusion: a cohort study

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Abstract

Study design

Clinical retrospective cohort study.

Objectives

To explore the application of the electromagnetic navigation system in Endo-TLIF.

Materials and methods

From May 2019 to March 2020, 76 patients with single-segment lumbar spondylolisthesis treated by electromagnetic navigation-assisted Endo-TLIF (NE group) and conventional Endo-TLIF (CE group) were enrolled in the study. Time of pedicle screw implantation, entire operation time, the number of intraoperative X-ray fluoroscopy exposures, total blood loss, incision length, ambulation time, accuracy of pedicle screws, complications, visual analog scale for back and leg pain, Oswestry Disability Index, Japanese Orthopedic Association score and postoperative fusion rates were recorded, respectively.

Results

There were no significant differences in preoperative demographics between the NE and CE groups (P > 0.05). The mean number of intraoperative X-ray fluoroscopy exposures, guidewires insertion, entire operation time, total blood loss and adjustment rate of screws in the NE group were significantly less compared with the CE group (P < 0.05, respectively). There were no significant differences in clinical parameters between the two groups at different time points in the follow-up period (P > 0.05). There was no statistical difference in fusion rates between the two groups. In addition, one case of cage subsidence was observed after surgery in the CE group.

Conclusion

Electromagnetic navigation systems could be applied throughout the entire surgical course and ameliorate the shortcomings of the conventional Endo-TLIF technique to reduce radiation exposure, improve accuracy, avoid repetitive operations and shorten surgery time and the required learning curve of the procedure.

Level of evidence I

Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to the data is confidential patient data but are available from the corresponding author on reasonable request.

References

  1. Foley KT, Lefkowitz MA (2002) Advances in minimally invasive spine surgery. Clin Neurosurg 49:499–517

    PubMed  Google Scholar 

  2. Wang J, Zhou Y, Feng Zhang Z, Qing Li C, Jie Zheng W, Liu J (2014) Comparison of the clinical outcome in overweight or obese patients after minimally invasive versus open transforaminal lumbar interbody fusion. J Spinal Disord Tech 27(4):202–206. https://doi.org/10.1097/BSD.0b013e31825d68ac

    Article  CAS  PubMed  Google Scholar 

  3. Lin EY, Kuo YK, Kang YN (2018) Effects of three common lumbar interbody fusion procedures for degenerative disc disease: a network meta-analysis of prospective studies. Int J Surg 60:224–230. https://doi.org/10.1016/j.ijsu.2018.11.009

    Article  PubMed  Google Scholar 

  4. Zhang H, Zhou C, Wang C, Zhu K, Tu Q, Kong M et al (2021) Percutaneous endoscopic transforaminal lumbar interbody fusion: technique note and comparison of early outcomes with minimally invasive transforaminal lumbar interbody fusion for lumbar spondylolisthesis. Int J Gen Med 14:549–558. https://doi.org/10.2147/ijgm.S298591

    Article  PubMed  PubMed Central  Google Scholar 

  5. Syed H, Voyadzis JM (2016) True percutaneous transforaminal lumbar interbody fusion: case illustrations, surgical technique, and limitations. J Neurol Surg A Cent Eur Neurosurg 77(4):344–353. https://doi.org/10.1055/s-0035-1558821

    Article  PubMed  Google Scholar 

  6. Ao S, Zheng W, Wu J, Tang Y, Zhang C, Zhou Y et al (2020) Comparison of preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital: Is percutaneous endoscopic procedure superior to MIS-TLIF? A prospective cohort study. Int J Surg 76:136–143. https://doi.org/10.1016/j.ijsu.2020.02.043

    Article  PubMed  Google Scholar 

  7. Park P (2015) Three-dimensional computed tomography-based spinal navigation in minimally invasive lateral lumbar interbody fusion: feasibility, technique, and initial results. Neurosurgery 11:259–267. https://doi.org/10.1227/neu.0000000000000726

    Article  PubMed  Google Scholar 

  8. Kato A, Yoshimine T, Hayakawa T, Tomita Y, Ikeda T, Mitomo M et al (1991) A frameless, armless navigational system for computer-assisted neurosurgery. Technical note. J Neurosurg 74(5):845–849. https://doi.org/10.3171/jns.1991.74.5.0845

    Article  CAS  PubMed  Google Scholar 

  9. Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G (2019) STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int J Surg 72:156–165. https://doi.org/10.1016/j.ijsu.2019.11.002

    Article  PubMed  Google Scholar 

  10. Neo M, Sakamoto T, Fujibayashi S, Nakamura T (2005) The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine 30(24):2800–2805. https://doi.org/10.1097/01.brs.0000192297.07709.5d (Phila Pa 1976)

    Article  PubMed  Google Scholar 

  11. Rothman SL, Glenn WV Jr (1985) CT evaluation of interbody fusion. Clin Orthop Relat Res 193:47–56

    Article  Google Scholar 

  12. Chafetz N, Cann CE, Morris JM, Steinbach LS, Goldberg HI, Ax L (1987) Pseudarthrosis following lumbar fusion: detection by direct coronal CT scanning. Radiology 162(3):803–805. https://doi.org/10.1148/radiology.162.3.3809497

    Article  CAS  PubMed  Google Scholar 

  13. Hernandez D, Garimella R, Eltorai AEM, Daniels AH (2017) Computer-assisted Orthopaedic Surgery. Orthop Surg 9(2):152–158. https://doi.org/10.1111/os.12323

    Article  PubMed  PubMed Central  Google Scholar 

  14. von Jako R, Finn MA, Yonemura KS, Araghi A, Khoo LT, Carrino JA et al (2011) Minimally invasive percutaneous transpedicular screw fixation: increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system. Acta Neurochir 153(3):589–596. https://doi.org/10.1007/s00701-010-0882-4 (Wien)

    Article  Google Scholar 

  15. Harijan A, Halvorson EG (2011) Eponymous instruments in plastic surgery. Plast Reconstr Surg 127(1):456–465. https://doi.org/10.1097/PRS.0b013e3181fcb170

    Article  CAS  PubMed  Google Scholar 

  16. Hahn P, Oezdemir S, Komp M, Giannakopoulos A, Kasch R, Merk H et al (2015) Navigation of pedicle screws in the thoracic spine with a new electromagnetic navigation system: a human cadaver study. Biomed Res Int 2015:183586. https://doi.org/10.1155/2015/183586

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ewurum CH, Guo Y, Pagnha S, Feng Z, Luo X (2018) Surgical navigation in orthopedics: workflow and system review. Adv Exp Med Biol 1093:47–63. https://doi.org/10.1007/978-981-13-1396-7_4

    Article  PubMed  Google Scholar 

  18. Xu D, Han S, Wang C, Zhu K, Zhou C, Ma X (2021) The technical feasibility and preliminary results of minimally invasive endoscopic-TLIF based on electromagnetic navigation: a case series. BMC Surg 21(1):149. https://doi.org/10.1186/s12893-021-01148-9

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC et al (2012) Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 21(2):247–255. https://doi.org/10.1007/s00586-011-2011-3

    Article  PubMed  Google Scholar 

  20. Schlenzka D, Laine T, Lund T (2000) Computer-assisted spine surgery. Eur Spine J 9(Suppl 1):S57-64. https://doi.org/10.1007/pl00010023

    Article  PubMed  Google Scholar 

  21. Wu XB, Fan GX, Gu X, Shen TG, Guan XF, Hu AN et al (2016) Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study. J Zhejiang Univ Sci B 17(7):553–560. https://doi.org/10.1631/jzus.B1600002

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wu J, Liu H, Ao S, Zheng W, Li C, Li H et al (2018) Percutaneous endoscopic lumbar interbody fusion: technical note and preliminary clinical experience with 2-Year follow-Up. Biomed Res Int 2018:5806037. https://doi.org/10.1155/2018/5806037

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hoogland T, Schubert M, Miklitz B, Ramirez A (2006) Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine 31(24):E890-897. https://doi.org/10.1097/01.brs.0000245955.22358.3a (Phila Pa 1976)

    Article  PubMed  Google Scholar 

  24. Kim HS, Raorane HD, Wu PH, Heo DH, Sharma SB, Jang IT (2020) Incidental durotomy during endoscopic stenosis lumbar decompression: incidence, classification, and proposed management strategies. World Neurosurg 139:e13-22. https://doi.org/10.1016/j.wneu.2020.01.242

    Article  PubMed  Google Scholar 

  25. Zhou C, Zhang G, Panchal RR, Ren X, Xiang H, Xuexiao M et al (2018) Unique complications of percutaneous endoscopic lumbar discectomy and percutaneous endoscopic interlaminar discectomy. Pain Physician 21(2):E105-112

    PubMed  Google Scholar 

  26. Malham GM, Parker RM, Blecher CM, Seex KA (2015) Assessment and classification of subsidence after lateral interbody fusion using serial computed tomography. J Neurosurg Spine 23(5):589–597. https://doi.org/10.3171/2015.1.Spine14566

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank all the staff members in the Orthopedic Medical Center of the Affiliated Hospital of Qingdao University.

Funding

This work was supported by grants from the National Natural Science Foundation of China (81672200, 81871804) and National Key Research and Development Project (CN) (2019YFC0121400).

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Author notes

  1. Hao Zhang and Derong Xu have equally contributed to this work.

Authors and Affiliations

  1. Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China

    Hao Zhang, Derong Xu, Chao Wang, Kai Zhu, Jianwei Guo, Chong Zhao, Jialuo Han, Houchen Liu, Xuexiao Ma & Chuanli Zhou

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  1. Hao Zhang
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Correspondence to Xuexiao Ma or Chuanli Zhou.

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The authors report that they have no conflict of interest in this work.

Human and animal rights

This clinical retrospective cohort study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University. Approved No. of ethic committee: QYFYWZLL26493. Written informed consent was obtained from all participants. Meanwhile, all personal details were erased before analysis to cover patient data and comply with the Declaration of Helsinki.

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Zhang, H., Xu, D., Wang, C. et al. Application of electromagnetic navigation in endoscopic transforaminal lumbar interbody fusion: a cohort study. Eur Spine J 31, 2597–2606 (2022). https://doi.org/10.1007/s00586-022-07280-1

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