Jonathan N Sellin1, Rory R Mayer2, Marcus Hoffman3, Alexander E Ropper4. 1. Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA. 2. Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA. 3. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA. 4. Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA. Electronic address: Alexander.Ropper@bcm.edu.
Abstract
OBJECTIVES: The advent of minimally invasive, percutaneous techniques for the placement of pedicle screws has led to the evolution of a popular treatment paradigm: anterior or lateral interbody fusions followed by posterior percutaneous pedicle screw placement. We present the operative technique for anterior-to-psoas lateral interbody fusion (ATP-LIF) with simultaneous posterior lumbar percutaneous pedicle screw fixation using intraoperative CT-guided navigation. PATIENTS AND METHODS: This technique capitalizes both on the more oblique approach used in the ATP-LIF procedure, as well as the anatomic clarity gleaned from intraoperative CT-guided navigation, to allow for simultaneous placement of pedicle screws in the lateral position without the need for guiding fluoroscopy. RESULTS: The parallel execution of both procedures, in the lateral position, reduces operative time, consolidates a two-stage procedure into one stage, and eliminates the need for prone re-positioning. The use of intraoperative CT-guided navigation reduces the need for fluoroscopy and overall radiation exposure while allowing for pedicle screw placement and the-LIF procedure in truly simultaneous fashion. In this pilot study, a total of 14 pedicle screws were placed with two lateral breaches (14%). CONCLUSION: Simultaneous Lateral Interbody and Pedicle Screws (SLIPS) represents a meaningful evolution of the newly reported single-position lateral interbody fusion with posterior percutaneous pedicle screw fixation.
OBJECTIVES: The advent of minimally invasive, percutaneous techniques for the placement of pedicle screws has led to the evolution of a popular treatment paradigm: anterior or lateral interbody fusions followed by posterior percutaneous pedicle screw placement. We present the operative technique for anterior-to-psoas lateral interbody fusion (ATP-LIF) with simultaneous posterior lumbar percutaneous pedicle screw fixation using intraoperative CT-guided navigation. PATIENTS AND METHODS: This technique capitalizes both on the more oblique approach used in the ATP-LIF procedure, as well as the anatomic clarity gleaned from intraoperative CT-guided navigation, to allow for simultaneous placement of pedicle screws in the lateral position without the need for guiding fluoroscopy. RESULTS: The parallel execution of both procedures, in the lateral position, reduces operative time, consolidates a two-stage procedure into one stage, and eliminates the need for prone re-positioning. The use of intraoperative CT-guided navigation reduces the need for fluoroscopy and overall radiation exposure while allowing for pedicle screw placement and the-LIF procedure in truly simultaneous fashion. In this pilot study, a total of 14 pedicle screws were placed with two lateral breaches (14%). CONCLUSION: Simultaneous Lateral Interbody and Pedicle Screws (SLIPS) represents a meaningful evolution of the newly reported single-position lateral interbody fusion with posterior percutaneous pedicle screw fixation.