A Prospective Comparison of the Effects of Instrument Tracking on Time and Radiation During Minimally Invasive Lumbar Interbody Fusion

World Neurosurg. 2021 Aug;152:e101-e111. doi: 10.1016/j.wneu.2021.05.058. Epub 2021 May 24.


Background: Minimally invasive surgical techniques have resulted in improved patient outcomes. One drawback has been the increased reliance on fluoroscopy and subsequent exposure to ionizing radiation. We have previously shown the efficacy of a novel instrument tracking system in cadaveric and preliminary clinical studies for commonplace orthopedic and spine procedures. In the present study, we examined the radiation and operative time using a novel instrument tracking system compared with standard C-arm fluoroscopy for patients undergoing minimally invasive lumbar fusion.

Methods: The radiation emitted, number of radiographs taken, and time required to complete 2 tasks were recorded between the instrument tracking systems and conventional C-arm fluoroscopy. The studied tasks included placement of the initial dilator through Kambin's triangle during percutaneous lumbar interbody fusion and placement of pedicle screws during both percutaneous lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion with or without instrument tracking.

Results: A total of 23 patients were included in the analysis encompassing 31 total levels. For the task of placing the initial dilator into Kambin's triangle, an average of 4.21 minutes (2.4 vs. 6.6 minutes; P = 0.002), 15 fluoroscopic images (5.4 vs. 20.5; P = 0.002), and 8.14 mGy (3.3 vs. 11.4; P = 0.011) were saved by instrument tracking. For pedicle screw insertion, an average of 5.69 minutes (3.97 vs. 9.67; P < 0.001), 14 radiographs (6.53 vs. 20.62; P < 0.001), and 7.89 mGy (2.98 vs. 10.87 mGy; P < 0.001) were saved per screw insertion.

Conclusions: Instrument tracking, when used for minimally invasive lumbar fusion, leads to significant reductions in radiation and operative time compared with conventional fluoroscopy.

Keywords: C-arm fluoroscopy; Computer-assisted; Instrument tracking; Intraoperative navigation; Lumbar fusion; Minimally invasive surgery; Radiation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Fluoroscopy / instrumentation
  • Fluoroscopy / methods*
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / instrumentation
  • Minimally Invasive Surgical Procedures / methods*
  • Neuronavigation / instrumentation
  • Neuronavigation / methods*
  • Operative Time*
  • Pedicle Screws
  • Prospective Studies
  • Radiation Exposure / prevention & control*
  • Spinal Fusion / instrumentation
  • Spinal Fusion / methods*
  • Tomography, X-Ray Computed / instrumentation
  • Tomography, X-Ray Computed / methods