• Masato Tanaka, Yoshihiro Fujiwara, Koji Uotani, Praful Maste, and Taro Yamauchi.
• Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan. Electronic address: tanaka0896@gmail.com.
• World Neurosurg. 2020 Nov 1; 143: 235-246.

BackgroundCircumferential minimally invasive surgery (cMIS), as a technique for reducing the complications of adult spinal deformity surgery, is receiving considerable attention. Conventional cMIS is performed using intraoperative fluoroscopy. In this work, we describe a new cMIS technique without using C-arm fluoroscopy for correcting adult spinal deformities.Case DescriptionA 70-year-old woman with symptomatic adult spinal deformity was referred to our hospital. The patient's daily life has been affected by severe low back pain for more than 4 years. The surgery was performed without C-arm fluoroscopy. The percutaneous pedicle screws and intervertebral cages were inserted only under navigation guidance. The patient was successfully treated with surgery, and her low back pain was well controlled. Her clinical outcomes were as follows: Oswestry Disability Index improved from 64% to 14% and the low back pain visual analog scale score improved from 75 mm to 24 mm at 1 year of final follow-up.ConclusionsC-arm-free cMIS for adult spinal deformity is a useful technique that reduces percutaneous screw and cage misplacement. With this new technique, the surgeons and the operation room staff can avoid the risk of an adverse event of intraoperative radiation.Copyright © 2020 Elsevier Inc. All rights reserved.

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