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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Preoperative simulation software reduces surgical time, decreases Radiation exposure and improves 6 months back pain in minimally invasive Hybrid Lumbar Interbody Fusion (MIS-HLIF)

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  • Witold Polanski - Universitätsklinik Dresden, Carl-Gustav-Carus Universitätsklinikum an der Technischen Universität Dresden, Dresden, Deutschland
  • Hongzhen Jiang - Department of Neurosurgery, University Hospital of Dresden, Dresden, Deutschland; Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Marek Molcanyi - Institute of Neurophysiology, Medical Faculty, University of Cologne, Köln, Deutschland
  • Jozef Zivcak - Department of Biomedical Engineering, Technical University of Kosice, Kosice, Slovakia
  • Daniel Ruess - Department of Stereotactic and Functional Neurosurgery, University of Cologne, Köln, Deutschland
  • Clemens Reinshagen - Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
  • Gabriele Schackert - Klinikum Carl Gustav Carus, Klinik und Poliklinik für Neurochirurgie, Carl-Gustav-Carus Universitätsklinikum an der Technischen Universität Dresden, Dresden, Deutschland
  • Bernhard Rieger - Universitätsklinikum Carl Gustav Carus der TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.05.03

doi: 10.3205/17dgnc206, urn:nbn:de:0183-17dgnc2066

Published: June 9, 2017

© 2017 Polanski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: MIS-HLIF was established as the standard lumbar interbody fusion in degenerative listhesis. It combines different screw trajectories (cortical bone trajectory and common pedicle screw placement) and the advantages of the PLIF and the TLIF within one surgical procedure. Due to the cortical bone trajectory, the surgical approach could be minimized and the tightness of the screws could be optimized, especially in osteoporosis and spondylodiscitis. Spinal navigation was introduced, to increase the safety with the unfamiliar cortical bone trajectory and led to an additional radiation exposure for the patient. Without any navigation guidance, percutaneous lumbar stabilization leads to an increased intraoperative radiation exposure in comparison with open procedures. Due to the implementation of the spinal navigation system and preoperative simulation software, the radiation exposure of the staff could be reduced.

Methods: 124 patients with a follow up of one year were enrolled in this inter cohort comparison. All patients underwent MIS-HLIF according to the standard operative procedure by one surgeon. Additionally to general surgery data, the radiation exposure in the OR was measured with the area dose product [cGy·cm2]. Outcome control of patients undergoing MIS-HLIF due to single level degenerative listhesis was done according the questionnaires of the European Spine Tango register. After establishing a preoperative simulation, 66 cases were evaluated (SIM group) and compared with 66 patients previously undergoing MIS-HLIF without preoperative simulation (NO-SIM group). Additionally, to observe the safety and efficacy of MIS-HLIF the outcome of all patients was considered in its entirety.

Results: The area dose product was reduced in our trained staff significantly for the SIM group (320cGy·cm2) in comparison with the NO-SIM group (470cGy·cm2) in navigation guided MIS-HLIF. The average surgical time was shorter for the SIM group (155min) than for the NO-SIM group (182min). In outcome register data there was less back pain (NRS back) after 6 months in the SIM group p=0.48. This trend disappeared after one year p=0.56. In overall consideration there was highly significant improvement in NRS back and leg, COMI and ODI in six weeks, three months, six months and one year follow-up (p<0.01).

Conclusion: MIS-HLIF combines advantages of the PLIF and TLIF procedure and its neurological outcome is equal to other lumbar stabilization procedures according the current literature. The implementation of preoperative simulation software reduced radiation exposure in our trained staff significantly and may lead to a better outcome due to its special algorithm which takes the individual degeneration into consideration. Based on preoperative imaging data, the simulation software suggests the optimal height of the device so it has not to be defined radiographically during the procedure.