Purpose: Single-position surgery with patients in a lateral position, which involves inserting percutaneous pedicular screws (PPS) and lateral interbody fusion (LIF) to avoid changing the position, has been reported. The purpose of the present study was to evaluate the utility and appropriateness of single-position LIF-PPS using O-arm-based navigation in the innovative oblique position.
Methods: This study involved a retrospective analysis of 92 consecutive patients with lumbar spondylolisthesis who underwent LIF-PPS using O-arm-based navigation. Thirty-five subjects demonstrated surgery with repositioning, as well as 24 in the lateral decubitus position, and 33 in the oblique during PPS, where the position was changed to the lateral decubitus position using bed rotation without resetting. We compared these three groups in terms of the surgery time, blood loss, and the accuracy of the screw placement.
Results: The operative time was significantly shorter in the single-position surgery, both in the lateral and oblique positions, compared to surgery in a dual position. The blood loss was significantly increased in the lateral position compared to the dual and oblique positions. The screw trajectory angle on the downside was significantly smaller in the lateral position, and the accuracy of the screw placement on the downside was significantly lower in the lateral position compared to the dual and oblique positions.
Conclusion: Single-position surgery could reduce the average surgery time by about 60 min. The present study indicated the oblique position during PPS insertion might make single-position surgery more useful to improve the accuracy of PPS on the downside, with less blood loss.
Keywords: CT navigation; O-arm; accuracy; lateral interbody fusion; minimally invasive technique; oblique position; percutaneous pedicle screw.