Single-Position Fluoroscopy-Guided Lateral Lumbar Interbody Fusion With Intraoperative Computed Tomography–Navigated Posterior Pedicle Screw Fixation: Technical Report and Literature Review

Accuracy of intraoperative navigation is verified at the transverse process of the most cranial level (furthest from iliac crest reference array). (A) Coronal, (B) axial, and (C) sagittal.

Pedicle screws of various sizes and dimensions can be virtually sized (red). (A) Axial and (B) sagittal.

Magnetic resonance imaging (MRI) lumbar spine. (A) Sagittal T2 MRI lumbar spine most notable for loss of disc height at L3/4 and L4/5. Severe stenosis is evident at L3/4 and L4/5. (B) Axial T2 MRI at L4/5 demonstrating severe central stenosis.

Plain film x-ray images. (A) Standing lateral x-ray image. Significant disc height loss is evident in L3/4 and L4/5. Note level of iliac crest (green dots) allowing access to L4/5 disc space laterally. (B) Standing anteroposterior x-ray image without major coronal imbalance. Levoscoliosis with apex at L3 measures 24° and minor curve between T7 and T12 measures 18°. (C) Flexion x-ray images and (D) extension view demonstrate instability with pathologic movement most notable at L4/5.

Intraoperative fluoroscopy (lateral view) demonstrating lordotic interbody cages placed at L3/4 and L4/5.

Percutaneous pedicle screws with integrated stylet tip (red) are used. The stylet tip is placed at the entry point for the pedicle screw, and the trajectory is optimized. (A) Axial and (B) sagittal.

As the pedicle screw is advanced, the trajectory is continuously monitored via navigation. Additionally, after the screw enters the vertebral body, the stylet tip is retracted (red tip no longer visible). (A) Coronal, (B) axial, and (C) sagittal.