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Instrument Tracking Reduces Radiation Exposure and Increases Efficiency in Prone Lateral Lumbar Interbody Fusion: A
Favour C Ononogbu-Uche1, Abdullah W Saleh1, Felix Toussaint1
1Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA.
International Journal of Spine Surgery
|June 19, 2026
Summary
Instrument tracking significantly reduces psoas retraction time and radiation exposure during prone lateral lumbar interbody fusion (PL-LIF). This technology enhances procedural efficiency and safety, leading to improved patient outcomes.
Area of Science:
- Minimally Invasive Spine Surgery
- Spinal Fusion Techniques
- Surgical Navigation Technology
Background:
- Prone lateral lumbar interbody fusion (PL-LIF) offers advantages over open surgery but raises concerns about psoas retraction time and radiation exposure.
- Instrument tracking, proven in other minimally invasive surgeries, has not been studied for PL-LIF.
- This study investigates the impact of instrument tracking on PL-LIF efficiency and safety.
Purpose of the Study:
- To evaluate the effect of instrument tracking on psoas retraction duration in PL-LIF.
- To assess the impact of instrument tracking on intraoperative radiation exposure during PL-LIF.
- To determine the influence of instrument tracking on procedural efficiency and patient-reported outcomes in PL-LIF.
Main Methods:
- Retrospective analysis of 52 PL-LIF levels in 39 patients over 7 months, utilizing instrument tracking.
- Analysis of operative times, radiation exposure (mGy, x-ray count), and patient-reported outcome measures (PROMs).
- Data divided into temporal quartiles to assess learning curve effects and surgeon experience with instrument tracking.
Main Results:
- Median retractor time decreased by 30% from the first to the final quartile (20.9 to 14.7 minutes, P=0.028).
- Frequency of retractor times under 20 minutes increased from 46% to 85% (P=0.04) by the final quartile.
- Significant reductions in retractor time were observed in later quartiles (P < 0.001), with radiation exposure also reduced.
Conclusions:
- Instrument tracking significantly decreases psoas retraction time and intraoperative radiation exposure in PL-LIF.
- The technology improves procedural efficiency, with retractor times falling below 15 minutes and meeting the 20-minute threshold in 85% of final quartile cases.
- Instrument tracking enhances safety and efficiency in PL-LIF while maintaining positive 12-month patient-reported outcome gains.
