Simultaneous Navigated Posterior Instrumentation and Anterior Exposure Improves Operative Efficiency and Maintains Safety in Lateral Single Position Surgery

Study Design: Retrospective review of consecutively, prospectively enrolled patients. Objective: To evaluate the impact of navigation for percutaneous pedicle screw fixation (PPSF) in lateral decubitus single position surgery (L-SPS) on operative efficiency and safety. Summary of Background Data: Posterior instrumentation is increasingly being performed in the lateral decubitus position. In L-SPS, PPSF is most often performed using a fluoroscopic technique. However, the utilisation of computer-assisted navigation enables simultaneous anterior exposure to be performed and limits radiation exposure to operating staff. Methods: L-SPS patients involving anterior lumbar interbody fusion (ALIF) with or without additional lateral lumbar interbody fusion (LLIF) were divided according to the PPSF technique. “Nav” patients had PPSF utilising computer navigation with simultaneous anterior exposure. “Fluoro” patients had PPSF under fluoroscopy performed either before or following anterior exposure. Results: Two hundred seventy-three patients were included, 187 “Nav” and 86 “Fluoro” patients. In total, 1036 pedicle screws were inserted, 708 navigated, and 328 fluoroscopic. Mean posterior levels (1.89 vs . 1.91, P = 0.910) and ALIF levels fused (1.17 vs . 1.13, P = 0.435) were similar. Mean operative time was significantly reduced in the “Nav” group (116.83 vs. 148.54 min, P < 0.001; 21.3% reduction). Estimated blood loss (258.28 vs . 188.53 mL, P = 0.066) and length of stay (2.33 vs. 2.24 d, P = 0.730) were not statistically significant. Patient radiation dose (91.11 vs. 46.47 mGy, P < 0.001) and radiation time (132.82 vs. 117.20 seconds, P < 0.001) were higher among “Nav” patients. Intraoperative complications (4.3% vs. 2.3%, P = 0.425) including vascular injury (2.1% vs. 0.0%, P = 0.172) and instrumentation-related complications (2.1% vs. 2.3%, P = 0.922) were not statistically significant. Postoperative complications (12.8% vs. 20.9%, P = 0.112) and reoperation rates within 90 days (3.2% vs. 7.0%, P = 0.158) were not statistically significant. No posterior instrumentation-related revisions were observed among “Nav” patients, compared with 2.3% of “Fluoro” patients ( P = 0.036). Conclusions: Simultaneously navigating posterior instrumentation during anterior exposure in L-SPS improves operative efficiency and may reduce instrumentation-related complications without compromising safety.