Citation: xilin liu, jacob r joseph, brandon w smith, yamaan saadeh, paul park, analysis of intraoperative cone-beam computed tomography combined with image guidance for lateral lumbar interbody fusion, operative neurosurgery, volume 14, issue 6, june 2018, pages 620¿626, h ttps://doi.Org/10.1093/ons/opx176 summary: background: minimally invasive lateral lumbar interbody fusion (llif) is traditionally performed with biplanar fluoroscopy.Recent literature demonstrates that intraoperative cone-beam computed tomography combined with spinal navigation can be safely utilized for localization and cage placement in llif.Objective: to evaluate the accuracy and safety of cage placement using spinal navigation in llif, as well as to evaluate the radiation exposure to surgeon and staff during the procedure.Methods: the authors performed a retrospective analysis of a prospectively acquired database of patients undergoing llif with image- based navigation performed from april 2014 to july 2016 at a single institution.The medical records were reviewed, and data on clinical outcomes, cage accuracy, complications, and radiation exposure were recorded.All patients underwent a minimum 30-d clinical follow-up to assess intraoperative and short term complications associated with their llif.Results: sixty-three patients comprising 117 spinal levels were included in the study.There were 36 (57.1%) female and 27 (42.9%) male patients.Mean age was 62.7 yr (range 24-79 yr).A mean 1.9 (range 1-4) levels per patient were treated.Cages were placed in the anterior or middle of 115 (98.3%) disc spaces.Image-guided cage trajectory was accurate in 116/117 levels (99.1%).In a subgroup analysis of 18 patients, mean fluoroscopy time was 11.7 ± 9.7 s per level.Sixteen (25.4%) patients experienced a complication related to approach.Conclusion: use of intraoperative cone-beam computed tomography combined with spinal navigation for llif results in accurate and safe cage placement as well as significantly decreased surgeon and staff radiation exposure.Reported events: sixteen patients encountered approach related complications.Nine patients had mild transient hip weakness.Three patients had transient hip/thigh numbness.Four patients had persistent mild hip/thigh numbness at last follow-up.Two patients had superficial wound infections.One patient developed a psoas abscess treated with percutaneous drainage.One patient developed asymptomatic myositis ossificans.Three patients had perioperative myocardial infarctions.One patient developed miller-fisher acute intermittent demyelinating polyneuropathy.Two patients had uncomplicated ileus.One patient had transient urinary retention.One patient had perioperative pneumonia.
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