Minimally Invasive Transforaminal Lumbar Interbody Fusion using 3-Dimensional Total Navigation: 2-Dimensional Operative Video

This video demonstrates the workflow of a minimally invasive transforaminal interbody fusion (MIS-TLIF) using a portable intraoperative CT (iCT) scanner, (Airo (R), Brainlab AG, Feldkirchen, Germany), combined with state-of-the-art total 3D computer navigation. The navigation is used not only for instrumentation but also for intraoperative planning throughout the procedure, inserting the cage, therefore, completely eliminating the need for fluoroscopy. In this video, we present a case of a 72-yr-old female patient with a history of lower back pain, right lower extremity radicular pain and weakness for 2 yr due to L4-L5 spondylolisthesis with instability and severe lumbar spinal stenosis. The patient is treated by a L4-L5 unilateral laminotomy for bilateral decompression (ULBD) and MIS-TLIF. MIS-TLIF using total 3D navigation significantly improves the workflow of the conventional TLIF procedure. The tailored access to the spine is translated into smaller but more efficient surgical corridors. This modification in a total navigationmodality minimizes the staff radiation exposure to 0 by navigating in real time over iCT obtained images that can be acquired while the surgical staff is protected or outside the OR. Furthermore, this technique makes real-time and virtual intraoperative imaging of screws and their planned trajectory feasible. 3D Navigation eliminates the need for K-Wires, thus decreasing the risk of vascular penetration injury due to K-Wire malpositioning. 3D navigation can also predict the positioning of the interbody cage, thereby, decreasing the risk of malpositioning or subsidence. Patient consent was obtained prior to performing the procedure.