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


Study design

Clinical retrospective cohort study.


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.


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.


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.


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


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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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 (2022).

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  • Electromagnetic navigation
  • Endoscopic transforaminal lumbar interbody fusion
  • Lumbar spondylolisthesis
  • Intraoperative fluoroscopy
  • Operation time