Related Experiment Video
Updated: Jan 11, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Intraoperative navigation-based lumbar facet assessment for considering fusion in unilateral biportal endoscopic cyst
Shailesh Hadgaonkar1, Sameer Nagpal1, Pramod Dashrath Bhilare1
1Department of Spine Surgery, Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India.
Background:
Overly extensive removal of the facet joint during lumbar facet synovial cyst (SC) excision may lead to iatrogenic instability. The objective of this study was to evaluate whether intraoperative navigation could better guide decisions regarding the need for simultaneous fusion.
Methods:
This prospective, single-surgeon study included eight patients with magnetic resonance imaging-confirmed lumbar SCs refractory to ≥6 weeks of conservative management. All underwent navigation-assisted unilateral biportal endoscopic decompression. Patients with preoperative dynamic X-ray evidence of instability were excluded. Intraoperative navigation quantified facet joint resection; those with ≤50% resection (Group A, n = 2) underwent decompression alone, while those with >50% resection (Group B, n = 6) underwent unilateral instrumentation with interbody fusion. Outcomes at 12 months included Visual Analog Scale (VAS) (back and leg pain), Oswestry Disability Index (ODI), and radiographic evaluation for fusion or instability on plain and dynamic radiographs.
Results:
The mean age was 48.6 years, and most procedures were performed at L4-L5. Postoperative VAS and ODI scores documented improvement in all cases at 12 months. In Group B, 100% achieved radiographic fusion, while none of the Group A patients developed postoperative instability.
Conclusion:
Intraoperative navigation allowed objective quantification of facet resection, guiding the selective use of fusion. Patients with >50% resection achieved solid fusion, while those with ≤50% remained stable without fusion. This navigation-guided, data-driven strategy personalizes surgical management, reduces overtreatment, and enhances biomechanical safety.
