• World Neurosurg · Nov 2023

    Minimally Invasive Approach for Degenerative Spondylolisthesis: Lateral Single-Position Surgery with Intraoperative CT Navigation and Fluoroscopy - A Technical Note.

    • Akihiko Hiyama, Hiroyuki Katoh, Daisuke Sakai, Masato Sato, and Masahiko Watanabe.
    • Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan. Electronic address: a.hiyama@tokai-u.jp.
    • World Neurosurg. 2023 Nov 1; 179: e500e509e500-e509.

    ObjectiveDegenerative spondylolisthesis (DS) is a prevalent condition that leads to low back pain and neurological symptoms. This technical note presents a novel surgical strategy for treating DS using lateral single-position surgery (SPS) in combination with intraoperative computed tomography navigation and fluoroscopy.MethodsFifteen patients (5 males and 10 females, mean age 70.2 years) diagnosed with DS with a slip of 5 mm or more underwent lateral lumbar interbody fusion (LLIF) with percutaneous pedicle screw (PPS) fixation using this technique. The procedure involved slip reduction using an upside PPS and rod fixation, followed by LLIF performed in the same lateral position. The term "upside PPS" refers to a PPS that is inserted on the ceiling side of the patient's surgical field. Preoperative and postoperative radiographic assessments were conducted to evaluate the effectiveness of the lateral SPS.ResultsThe results demonstrated significant improvements in various parameters, including spondylolisthesis reduction, segmental lordosis, disc height, and spinal canal dimensions. The lateral-SPS procedure exhibited several advantages over traditional flip LLIF approaches for slip reduction. Additionally, the technique provided accurate intraoperative navigation guidance through computed tomography imaging, ensuring precise implant placement and slip reduction.ConclusionsCombining LLIF and PPS fixation in a single procedure presents a precise, efficient approach for DS treatment, minimizing repositioning needs. This technique enables effective lumbar reconstruction, restoration of spinal stability, and improved patient outcomes. Although further investigation is warranted, lateral SPS surgery may hold promise as an innovative solution for managing DS by reducing surgical invasiveness and optimizing surgical efficiency.Copyright © 2023 Elsevier Inc. All rights reserved.

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