Clinical Efficiency and Radiation Safety of Fluoroscopy-Based 2D Intraoperative Computer Navigation in Biportal Spinal Endoscopy

<h3>Background</h3> Endoscopic spine surgery is a minimally invasive technique that can treat spinal conditions while resulting in less pain and faster recovery than alternative techniques. However, achieving precise navigation is challenging without significant radiation exposure and increased surgical times. Fluoroscopy-based 2-dimensional navigation (2DNAV) is an emerging technology that offers real-time navigation using intraoperative fluoroscopy. This study evaluated the clinical efficiency and radiation safety of 2DNAV in biportal endoscopic spine surgery as compared with conventional C-arm fluoroscopy. <h3>Methods</h3> This prospective comparative cohort study included 20 biportal endoscopic patients using 2DNAV and 20 case-matched control patients using C-arm fluoroscopy. Primary outcomes included operative time, number of fluoroscopic images, radiation exposure time, and total radiation dose. Additionally, a visual analog scale for back and leg pain and the Oswestry Disability Index were obtained. <h3>Results</h3> Mean operative time in the 2DNAV group (67.95 ± 14.4 minutes) was significantly shorter compared with the control group (83.0 ± 16.0 minutes, <i>P</i> = 0.003). The mean number of fluoroscopic images required was significantly less in the 2DNAV group (3.15 ± 1.6 images) with vs control group (17.95 ± 5.7 images, <i>P</i> &lt; 0.001). Total radiation exposure time was significantly lower in the 2DNAV group (mean 1.9 ± 1.1 min:sec) vs the control group (mean 9.21 ± 5.6 min:sec, <i>P</i> &lt; 0.001). 2DNAV group experienced mean radiation dose of 0.77 ± 0.4 mGy vs 6.21 ± 3.8 mGy in control (<i>P</i> &lt; 0.001). There were no significant differences in clinical outcomes. <h3>Conclusions</h3> 2DNAV significantly reduced operative times and required significantly fewer fluoroscopic images with lower radiation exposure for patients. 2DNAV allowed for the successful completion of the procedures with no difference in clinical outcomes. <h3>Clinical Relevance</h3> 2DNAV provides real-time instrument tracking and computer navigation during endoscopic spine surgery with significantly decreased operative time and radiation exposure with similar clinical outcomes as conventional fluoroscopy. <h3>Level of Evidence</h3> 2.