Should 3D Navigation be the Standard of Care for MIS TLIF?

Volume 4 | Issue 1 | April 2023 – September 2023 | page: 09-13 | Bharat R. Dave, Ajay Krishnan, Devanand Degulmadi, Shivanand Mayi, Ravi Ranjan Rai, Mirant B. Dave


Authors: Bharat R. Dave [1], Ajay Krishnan [1], Devanand Degulmadi [1], Shivanand Mayi [1], Ravi Ranjan Rai [1], Mirant B. Dave [1]

[1] Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Ravi Ranjan Rai,
Spine Surgeon, Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India.


Introduction- Traditionally MIS TLIF is being performed under fluoroscopic guidance, which is technically difficult in few cases, often inaccurate and involves excessive radiation exposure to the surgeon and OR personnel. Navigation promises to be a better tool, however, literature regarding its accuracy is still evolving.
Aims & Objectives- To evaluate the pedicle screw perforation rate in Navigation guided MIS TLIF
Materials and Methods- All consecutive patients undergoing MIS TLIF under 3D Navigation at single institute between January 2019 to January 2021 were included in the study. O-arm and S8 Stealth Navigation was used in all cases. After prone positioning and part preparation, patient tracker was fixed to a bony point nearest to the operative site, and then first CT scan spin was taken. Under Navigation guidance, all four guide wires were placed. Decompression was planned from the side which was more symptomatic. Screws on the opposite side were placed and connected with rod. Decompression was performed, and interbody cage was inserted from the symptomatic side, followed by insertion of remaining two screws under Navigation. A final CT scan spin was taken to determine the accuracy of hardware.
Results- 92 MIS TLIF were performed during the study period under 3D Navigation. 368 screws in 92 patients were analysed for accuracy. The direction and degree of breach was recorded. Four screws were found to breach, two were lateral breach, one superior breach and one medial breach. All breaches were Gr 1 and none of the screws required revision. Overall accuracy was 98.91 percent.
Conclusion- 3D Navigation is a useful tool in guiding placement of pedicle screws with high accuracy. This tool would be particularly indispensable in MISS cases, when tactile feedback is minimal.
Keywords- Surgical Navigation Systems, Computer-Assisted surgery, Minimally Invasive Surgical Procedures, Pedicle Screws.


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How to Cite this Article: Dave BR, Krishnan A, Degulmadi D, Mayi S, Rai RR, Dave MB | Should 3D Navigation be the Standard of Care for MIS TLIF?| Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 09-13 |

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