• Worawat Limthongkul, Waranyoo Wathanavasin, Vit Kotheeranurak, Thanadol Tangdamrongtham, Teerachat Tanasansomboon, Wicharn Yingsakmongkol, and Weerasak Singhatanadgige.
• Department of Orthopedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand.
• World Neurosurg. 2023 Aug 1; 176: e226e231e226-e231.

ObjectiveTo compare the efficacy of intervertebral disc space preparation via an anterior-to-psoas (ATP) approach using conventional fluoroscopy (Flu) and computer tomography (CT)-based navigation by evaluating the disc remaining area.MethodsWe equally assigned 24 lumbar disc levels from 6 cadavers into Flu and CT-based navigation (Nav) groups. Two surgeons performed disc space preparation using the ATP approach in both groups. Digital images of each vertebral endplate were obtained, and the remaining disc tissue was calculated in total and in quadrants. Operative time, number of attempts at disc removal, endplate violation area, number of endplate violation segments, and access angle were recorded.ResultsThe overall percentage of remaining disc tissue was significantly less in the Nav group than in the Flu group (32.7% vs. 43.3% respectively, P < 0.001). A significant difference was found in the posterior-ipsilateral (4.2% vs. 7.1%, P = 0.005) and posterior-contralateral (6.1% vs. 10.9%, P = 0.002) quadrants, respectively. No significant between-group difference was found concerning operative time, number of attempts at disc removal, endplate violation area, number of endplate violation segments, or access angle.ConclusionsIntraoperative CT-based navigation may improve vertebral endplate preparation quality for an ATP approach, especially in the posterior quadrants. This technique may offer an effective alternative disc space and endplate preparation methods and may help enhance the fusion rates.Copyright © 2023 Elsevier Inc. All rights reserved.

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