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Updated: Jan 11, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Computed tomography imaging for exploring the appropriate angle of a visible Trephine in endoscopic spine lumbar
Wei Wang1,2, Yukai Cui3, Xiaohao Sun3
1Department of Orthopaedic, Fuyang Hospital Affiliated with Bengbu Medical University (Fuyang People's Hospital), Fuyang, China.
Purpose:
Although endoscopic spine lumbar interbody fusion (Endo-LIF) is widely applied clinically, it still presents several shortcomings, including intraoperative disorientation, a high rate of nerve injuries, a steep learning curve, and extended operation times. There is a lack of quantification regarding the standards of surgical operations. Consequently, the standardization and quantification of surgical procedures are poised to become focal points for future research on Endo-LIF.
Methods:
The intervertebral spaces from L1 to L5 were selected, and three-dimensional (3D) computed tomography (CT) employed to identify Kambin's triangle and the inscribed circles within it. The angle "α" formed by the line connecting the center of the circle "O" to the center of the intervertebral disc "A" was recorded, as was the line connecting "A" to the center of the spinous process "B". This angle represents the approach angle of the visible trephine during surgery. Additionally, in the Mimics software 3D model, abrasion of the facet joints was observed when the visible trephine was positioned at the angle "α".
Results:
The abduction angle of the visible trephine in each intervertebral space from L1 to L5 exhibited a gradually increasing trend. When applying the trephine, the L1-L2, L2-L3, and L4-L5 intervertebral spaces showed measurements of 0°-31.35° (± 2.78), 0°-30.93° (± 2.80), and 0°-33.01° (± 3.49), respectively. Notable discrepancies were observed in the L3-L4 intervertebral space; specifically, the left side measured 0°-29.93° (± 0.75), while the right side measured 0°-32.01° (± 0.51).
Conclusions:
The authors believe that this study provides surgeons with an effective reference by significantly reducing time wasted due to improper trephine placement, shortening operative duration, and alleviating patient discomfort. Furthermore, by adhering to the quantified trephine placement angle, surgeons can perform procedures with more standardized and normative data guidance and substantially enhanced surgical safety. Finally, this study can be an important clinical reference for future research in path planning and precision operations in spinal surgery robotics.
