Dados do Trabalho

Título

Is the navigation a game changer in One Level Transforaminal Lumbar Interbody Fusions (OL-TLIFs)?

Objetivo

Navigation techniques have greatly evolved to incorporate and leverage advances in imaging technology. Intraoperative CT 3D modality (IoCT) has increasingly been used to assist the insertion of pedicle screws and all sort of approaches. Several studies have compared the accuracy associated with O-arm (an IoCT) use to freehand techniques and fluoroscopic guidance. Despite this evidence, only few studies have investigated the clinical ramifications of greater accuracy or even the differences of this use in specific cases, as on OL-TLIF. We hypothesized that, compared with the fluoroscopic guidance, increased accuracy achieved with the O-arm doesn’t have influence in the surgical time, time to discharge and blood loss, when we compare fusion in only one level TLIF (OL-TLIF).

Objective: Evaluate the role of the navigation in OL-TLIFs and identify differences in surgical time, time to discharge and blood loss parameters between fluoroscopic guided (FG) and O-arm guided (OG) TLIFs.

Metodologia

After a review of literature on the Medline database in the past 10 years. We found only 67 studies related to the field. Almost none evaluated clinical outcomes, and some evaluated larger surgeries. This is a retrospective case-control single center study on OL-TLIFs performed between 2019 – 2020 on the levels L2-S1 (comprising L2-3, L3-4, L4-5 and L5-S1), were the primary outcome is the use of a navigation technique. Exclusion criteria were: Trauma, infection, neoplasia, more than one level surgery (i.e. TLIF one level with decompression in two levels), deformity, anterior approaches, minimally invasive approaches and high degree spondylolisthesis defined as grade 3 or grater.

Resultados

From 92 cases, 48 was FG and 44 OG. The mean surgical time was 154 min, in the OG was 187 min and FG 124 min. The mean blood loss was 275 ml on the complete group. On the OG was 291 ml and the FG 259 ml. The mean time to discharge was 3.96 days. With OG performing 4.2 and FG 3.7 days of hospitalisation. Surgeries were performed mainly because of listhesis and stenosis. Between the listhesis group, degenerative cases were the most prevalent on FG but isthmic was the most on the OG group. A distribution analysis of sexe, age shows similar results between groups. 43% of the patients were BMI 31-40, 50% BMI 21-30 and 5% BMI > 40. The approach used was Midline in 82% of cases and Wiltse in 18% with an important trend to use of Wiltse approach in OG cases.

Conclusões

Our preliminary results show that in OL-TLIF we had no benefit in blood loss, time to discharge and surgical time from using OG screws. Further statistical analysis and broader number of patients will help us to better evaluate comparison between groups and may find specific ones that could have improvement with the OG technique. When we look for health systems with small budget that deals with a great amount of OL-TLIF this study may provide information on how to allocate resources. Further studies are needed for further statistical analysis.

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