gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Intraoperative evaluation of neural decompression via MIS-TLIF and MIS-ELIF using a novel intraoperative CT – A retrospective single center study of 34 patients

Meeting Abstract

  • presenting/speaker Gernot Lang - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Insa Janssen - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Rodrigo Navarro-Ramirez - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Ajit Jada - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Connor Berlin - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Micaella Zubkov - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Lena Gandevia - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Roger Hartl - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN28-91

doi: 10.3205/17dkou069, urn:nbn:de:0183-17dkou0691

Veröffentlicht: 23. Oktober 2017

© 2017 Lang et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Recently, a novel mobile intraoperative CT (iCT) was introduced, allowing for real time navigation and immediate intraoperative evaluation of neural decompression and implant position in spine surgery. The purpose of the study was to intraoperatively assess the degree of neural decompression through minimally invasive (MIS) extreme lateral interbody fusion (ELIF) and MIS transforaminal lumbar interbody fusion (TLIF) utilizing iCT.

Methods: A retrospective study of patients undergoing iCT-guided MIS-ELIF or MIS-TLIF was conducted. A portable iCT scanner was used for iCT-guided 3D navigation. For navigation, the iCT was connected to an image-guidance system and infrared tracking camera.

Pre- and intraoperative CT sequences were extracted and radiographic outcome parameters were measured. Radiographic parameters included (1) regional sagittal lumbar lordosis, (2) bilateral foraminal area, (3) intervertebral disc height, (4) facet tropism, and (5) facet joint degeneration. ODI and VAS for pain of back, buttock and leg were documented preoperatively, postoperatively and at the latest follow-up (24 hours, 2 weeks, and 3 and/or 6 months postoperatively). Postoperative pain evaluation was recorded 2 weeks postoperatively. The radiographic and clinical outcome scores were evaluated by blinded investigators. For continuous variables with repeated measurements, the differences were assessed using the independent t-test and ANOVA, as appropriate. Correlation between continuous variables was determined using Pearson's correlation for normally distributed variables and Spearman's correlation for non-normally distributed variables. All p-values were two-sided with statistical significance evaluated at p ≤ 0.05.

Results and Conclusion: 34 patients containing 41 spinal segments were analyzed. Intraoperative CT-based navigation was successfully accomplished in all patients. Radiographic parameters, including disc height (Δ=+4.3mm/+2.8mm), axial central canal surface area (Δ=+57.1mm²/+102.4mm²), foraminal area (Δ=+42.3mm²/+37.1mm²), segmental disc angle (Δ=+7.32°/+6.11°) and lumbar lordosis (Δ=+9.64°/+3.3°) revealed significant improvement after MIS-ELIF and MIS-TLIF (p≤ 0.05). Despite a significantly stronger restoration of disc height in MIS-ELIF compared to MIS-TLIF (p≤0.05) significant differences in morphological outcome were not observed between MIS-ELIF and MIS-TLIF (p≥ 0.05). Except VAS back pain and right leg pain clinical outcome revealed equivalent results for MIS-ELIF and MIS-TLIF at the last follow-up (p≤0.05).

Intraoperative CT was capable of assessing neural decompression by MIS-ELIF and MIS-TLIF with high accuracy. Both procedures demonstrated equivalent efficiency in neural decompression and restoration of spinal biomechanics. Intraoperative CT is a powerful tool for the assessment of instrumentation, cage position and neural decompression, providing the earliest possible feedback during MIS spine surgery.