Benefits of navigation for TLIF included shorter incision, less blood loss, & shorter stay

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
40 patients with single-level degenerative lumbar disc disease who were scheduled for transforaminal lumbar interbody fusion (TLIF) were randomized to undergo the procedure with or without the use of navigation technology. The purpose of this study was to compare perioperative outcomes, including incision length, intraoperative blood loss, operative time, postoperative blood loss, time to mobilization, and the length of hospital stay between groups, as well as the clinical outcomes at 3-month and 2-year follow-up. Significant differences in Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
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Why was this study needed now?
The investigation into computer navigation technology within orthopaedic procedures has been prolific in the past decade. The technology has now emerged for use in transforaminal lumbar interbody fusion, with the intention to reduce approach-related morbidities, such as incision length and blood loss. Nevertheless, randomized controlled trials comparing these outcomes to cases managed with a conventional approach are needed to justify the use of navigation in routine practice.
What was the principal research question?
In transforaminal lumbar interbody fusion, are there any significant differences in perioperative outcomes or 3-month clinical outcomes between navigated procedures and conventional procedures?
Population: 40 patients with symptomatic single-level degenerative lumbar disc disease who were scheduled for single-level transforaminal lumbar interbody fusion.
Intervention: Navigated group: A 4cm longitudinal median incision was made, followed by detachment of paravertebral muscles for exposure of the laminae. A patient tracker was fixed to the spinous process of the operative level using 3D C-arm imaging, which was then scanned and sent to the navigation workstation. Using the navigation technology, four pedicle screws were inserted. The tracker was then removed. Decompression, discectomy, and cage insertion were completed, and instrumentation rods were affixed. (n=20; Mean age: 50.6+/-12.7)
Comparison: Conventional group: Surgery was completed without the use of navigation technology. (n=20; Mean age: 51.5+/-10.0)
Outcomes: Perioperative outcomes included incision length, intraoperative blood loss, operative time, postoperative blood loss, time to mobilization, and length of hospital stay. Complications were also recorded. The Oswestry Disability Index was used to assess the clinical outcomes at follow-up.
Methods: RCT
Time: Perioperative outcomes were assessed during the hospital stay. ODI was assessed at 3 months and 2 years postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.