• World Neurosurg · Jan 2018

    A new volumetric radiological method to assess indirect decompression after XLIF using a high resolution intraoperative CT.

    • Rodrigo Navarro-Ramirez, Connor Berlin, Gernot Lang, Ibrahim Hussain, Insa Janssen, Stephen Sloan, Gulce Askin, Mauricio J Avila, Micaella Zubkov, and Roger Härtl.
    • Brain and Spine Center, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.
    • World Neurosurg. 2018 Jan 1; 109: 59-67.

    BackgroundTwo-dimensional radiographic methods have been proposed to evaluate the radiographic outcome after indirect decompression through extreme lateral interbody fusion (XLIF). However, the assessment of neural decompression in a single plane may underestimate the effect of indirect decompression on central canal and foraminal volumes. The present study aimed to assess the reliability and consistency of a novel 3-dimensional radiographic method that assesses neural decompression by volumetric analysis using a new generation of intraoperative fan-beam computed tomography scanner in patients undergoing XLIF.MethodsProspectively collected data from 7 patients (9 levels) undergoing XLIF was retrospectively analyzed. Three independent, blind raters using imaging analysis software performed volumetric measurements pre- and postoperatively to determine central canal and foraminal volumes. Intrarater and Interrater reliability tests were performed to assess the reliability of this novel volumetric method.ResultsThe interrater reliability between the three raters ranged from 0.800 to 0.952, P < 0.0001. The test-retest analysis on a randomly selected subset of three patients showed good to excellent internal reliability (range of 0.78-1.00) for all 3 raters. There was a significant increase in mean volume ≈20% for right foramen, left foramen, and central canal volumes postoperatively (P = 0.0472; P = 0.0066; P = 0.0003, respectively).ConclusionsHere we demonstrate a new volumetric analysis technique that is feasible, reliable, and reproducible amongst independent raters for central canal and foraminal volumes in the lumbar spine using an intraoperative computed tomography scanner.Copyright © 2017. Published by Elsevier Inc.

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