{"title":"微创经椎间孔腰椎椎体间融合的发展：15年队列中预导航、部分导航和完全导航的比较。","authors":"Yi-Hsuan Kuo, Chao-Hung Kuo, Tsung-Hsi Tu, Hsuan-Kan Chang, Chin-Chu Ko, Chih-Chang Chang, Li-Yu Fay, Wen-Cheng Huang, Jau-Ching Wu","doi":"10.1097/BRS.0000000000005249","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observation.</p><p><strong>Objective: </strong>To analyze the evolution and impact of navigation technology in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).</p><p><strong>Summary of background data: </strong>While navigated pedicle screw placement improves accuracy, reduces blood loss, and decreases radiation exposure for surgeons, longer operation times have also been reported.</p><p><strong>Methods: </strong>All patients who underwent MIS-TLIF between 2008 and 2022 were included. Physiological measures, including surgical disc levels, operation time, estimated blood loss, and the incidence of screw revision due to malposition, debridement, surgery for adjacent segment disease, or implant failure, were compared. Patients were divided into two groups: \"no navigation\" (fluoroscopic guidance) and \"navigation\" (from navigated screw placement to full navigation including decompression and interbody grafting, eliminating fluoroscopy). Year groups were further analyzed: 2008-2011 (no navigation), 2012-2015 (no navigation), 2016-2019 (navigation for screw placement), and 2020-2022 (total navigation).</p><p><strong>Results: </strong>A total of 823 patients (427 \"no navigation\" vs. 396 \"navigation\") were included. In one-disc-level non-navigated MIS-TLIF, operation time decreased across the years (266.0±63.9 [2008-2011] vs. 215.5±57.3 [2012-2015] vs. 191.7±41.8 [2016-2019] minutes, P<0.001). For navigated screw placement (2016-2019), navigation prolonged the duration of one-disc-level MIS-TLIF (241.7±106.2 vs. 191.7±41.8 min, P<0.001) but not in two-disc-level MIS-TLIF (293.1±74.1 vs. 302.8±69.8 min, P=0.544). Under total navigation (2020-2022), navigation barely affected the operation time in one-disc-level MIS-TLIF (194.8±54.6 vs. 190.2±47.4 min, P=0.663) and even accelerated two-disc-level surgery (279.9±64.1 vs. 362.7±80.7 min, P=0.002). There were no differences in blood loss and re-operation rate. The adaptation of navigation also facilitated long-segment (3- and 4-disc-level) cases, and the number gradually increased over years, though not sufficient for analyses.</p><p><strong>Conclusions: </strong>Spinal navigation accelerated MIS-TLIF in multi (2 or more) disc-level cases after establishment and evolved towards a fluoro-less workflow. Navigation expanded MIS-TLIF to multi-level cases at similarly low complications rates.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evolution of Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Pre-, Partial-, and Full-navigation in a 15-year Cohort.\",\"authors\":\"Yi-Hsuan Kuo, Chao-Hung Kuo, Tsung-Hsi Tu, Hsuan-Kan Chang, Chin-Chu Ko, Chih-Chang Chang, Li-Yu Fay, Wen-Cheng Huang, Jau-Ching Wu\",\"doi\":\"10.1097/BRS.0000000000005249\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective observation.</p><p><strong>Objective: </strong>To analyze the evolution and impact of navigation technology in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).</p><p><strong>Summary of background data: </strong>While navigated pedicle screw placement improves accuracy, reduces blood loss, and decreases radiation exposure for surgeons, longer operation times have also been reported.</p><p><strong>Methods: </strong>All patients who underwent MIS-TLIF between 2008 and 2022 were included. Physiological measures, including surgical disc levels, operation time, estimated blood loss, and the incidence of screw revision due to malposition, debridement, surgery for adjacent segment disease, or implant failure, were compared. Patients were divided into two groups: \\\"no navigation\\\" (fluoroscopic guidance) and \\\"navigation\\\" (from navigated screw placement to full navigation including decompression and interbody grafting, eliminating fluoroscopy). Year groups were further analyzed: 2008-2011 (no navigation), 2012-2015 (no navigation), 2016-2019 (navigation for screw placement), and 2020-2022 (total navigation).</p><p><strong>Results: </strong>A total of 823 patients (427 \\\"no navigation\\\" vs. 396 \\\"navigation\\\") were included. In one-disc-level non-navigated MIS-TLIF, operation time decreased across the years (266.0±63.9 [2008-2011] vs. 215.5±57.3 [2012-2015] vs. 191.7±41.8 [2016-2019] minutes, P<0.001). For navigated screw placement (2016-2019), navigation prolonged the duration of one-disc-level MIS-TLIF (241.7±106.2 vs. 191.7±41.8 min, P<0.001) but not in two-disc-level MIS-TLIF (293.1±74.1 vs. 302.8±69.8 min, P=0.544). Under total navigation (2020-2022), navigation barely affected the operation time in one-disc-level MIS-TLIF (194.8±54.6 vs. 190.2±47.4 min, P=0.663) and even accelerated two-disc-level surgery (279.9±64.1 vs. 362.7±80.7 min, P=0.002). There were no differences in blood loss and re-operation rate. The adaptation of navigation also facilitated long-segment (3- and 4-disc-level) cases, and the number gradually increased over years, though not sufficient for analyses.</p><p><strong>Conclusions: </strong>Spinal navigation accelerated MIS-TLIF in multi (2 or more) disc-level cases after establishment and evolved towards a fluoro-less workflow. Navigation expanded MIS-TLIF to multi-level cases at similarly low complications rates.</p><p><strong>Level of evidence: </strong>Level 3.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-04-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005249\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005249","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Evolution of Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Pre-, Partial-, and Full-navigation in a 15-year Cohort.
Study design: Retrospective observation.
Objective: To analyze the evolution and impact of navigation technology in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
Summary of background data: While navigated pedicle screw placement improves accuracy, reduces blood loss, and decreases radiation exposure for surgeons, longer operation times have also been reported.
Methods: All patients who underwent MIS-TLIF between 2008 and 2022 were included. Physiological measures, including surgical disc levels, operation time, estimated blood loss, and the incidence of screw revision due to malposition, debridement, surgery for adjacent segment disease, or implant failure, were compared. Patients were divided into two groups: "no navigation" (fluoroscopic guidance) and "navigation" (from navigated screw placement to full navigation including decompression and interbody grafting, eliminating fluoroscopy). Year groups were further analyzed: 2008-2011 (no navigation), 2012-2015 (no navigation), 2016-2019 (navigation for screw placement), and 2020-2022 (total navigation).
Results: A total of 823 patients (427 "no navigation" vs. 396 "navigation") were included. In one-disc-level non-navigated MIS-TLIF, operation time decreased across the years (266.0±63.9 [2008-2011] vs. 215.5±57.3 [2012-2015] vs. 191.7±41.8 [2016-2019] minutes, P<0.001). For navigated screw placement (2016-2019), navigation prolonged the duration of one-disc-level MIS-TLIF (241.7±106.2 vs. 191.7±41.8 min, P<0.001) but not in two-disc-level MIS-TLIF (293.1±74.1 vs. 302.8±69.8 min, P=0.544). Under total navigation (2020-2022), navigation barely affected the operation time in one-disc-level MIS-TLIF (194.8±54.6 vs. 190.2±47.4 min, P=0.663) and even accelerated two-disc-level surgery (279.9±64.1 vs. 362.7±80.7 min, P=0.002). There were no differences in blood loss and re-operation rate. The adaptation of navigation also facilitated long-segment (3- and 4-disc-level) cases, and the number gradually increased over years, though not sufficient for analyses.
Conclusions: Spinal navigation accelerated MIS-TLIF in multi (2 or more) disc-level cases after establishment and evolved towards a fluoro-less workflow. Navigation expanded MIS-TLIF to multi-level cases at similarly low complications rates.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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