TY - JOUR TI - Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion AU - AU - Safaee, Michael AU - AU - Oh, Taemin AU - AU - Pekmezci, Murat AU - AU - Clark, Aaron J. DA - 2019/08/06/ PY - 2019 KW - Medicine KW - Image-guidance KW - minimally invasive KW - transforaminal lumbar interbody fusion KW - spinal surgery KW - intraoperative guidance KW - spinal fusion AB - Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. Minimally invasive surgery (MIS) approaches have been applied to this technique with an associated decrease in estimated blood loss (EBL), length of hospital stay, and infection rates, while preserving outcomes with traditional open surgery. Previous MIS TLIF techniques involve significant fluoroscopy that subjects the patient, surgeon, and operating room staff to non-trivial levels of radiation exposure, particularly for complex multi-level procedures. We present a technique that utilizes an intraoperative computed tomography (CT) scan to aid in placement of pedicle screws, followed by traditional fluoroscopy for confirmation of cage placement. Patients are positioned in the standard fashion and a reference arc is placed in the posterior superior iliac spine (PSIS) followed by intraoperative CT scan. This allows for image-guidance-based placement of pedicle screws through a one-inch skin incision on each side. Unlike traditional MIS-TLIF that requires significant fluoroscopic imaging during this stage, the operation can now be performed without any additional radiation exposure to the patient or operating room staff. After completion of the facetectomy and discectomy, final TLIF cage placement is confirmed with fluoroscopy. This technique has the potential to decrease operative time and minimize total radiation exposure. UR - http://www.sunshinejia.com/video/57830 SP - e57830 IS - 150 PB - MyJoVE Corp JO - JoVE SN - 1940-087X DO - doi:10.3791/57830 ER -