O-arm Navigation-assisted Extreme Lateral Interbody Fusion Utilizing SureTrak Device

Currently, intraoperative guidance during conventional extreme lateral interbody fusion relies primarily on fluoroscopy, which can expose both surgical staff and the patient to radiation. The use of O-arm navigation during extreme lateral interbody fusion and percutaneous pedicle screw fixation is anticipated to enhance accuracy and substantially reduce radiation exposure. To date, there have been no published studies investigating the application of O-arm navigation in extreme lateral interbody fusion procedures. Thirty-three extreme lateral interbody fusion and percutaneous pedicle screw fixation procedures were performed using O-arm navigation in a semi-lateral setup, including 25 single-level and 8 2-level cases. Pathologies included 23 cases of lumbar degenerative spondylolisthesis, 8 canal stenosis, and 2 spondylolytic spondylolisthesis. For each patient, we collated key parameters, including operative time, blood loss, radiation exposure/doses, Japanese Orthopaedic Association score, and Oswestry Disability Index. Patients were placed in a single position. percutaneous pedicle screw fixation was first performed under O-arm guidance; subsequently, disc preparation and cage insertion were navigation-assisted using the SureTrak device. The control group included 33 patients who underwent extreme lateral interbody fusion with C-arm fluoroscopy. Operative time and blood loss were similar between the O-arm navigated extreme lateral interbody fusion and fluoroscopy-guided extreme lateral interbody fusion groups. The O-arm navigated extreme lateral interbody fusion group demonstrated an 85% reduction in radiation time (11.10 ± 5.44 seconds versus 72.94 ± 17.99 seconds), as well as a 77% decrease in radiation dose (1.50 ± 0.38 versus 6.52 ± 5.30 mGy). Both groups showed notable postoperative improvements in Japanese Orthopaedic Association and Oswestry Disability Index scores. Extreme lateral interbody fusion with O-arm navigation demonstrated practicality, reliability, accuracy, and precise cage placement. Enhanced anatomical visualization reduced radiation exposure among surgical personnel.