Is Navigation a Game Changer in Single Level Transforaminal Lumbar Interbody Fusions (SL‐TLIFs)?

Introduction: Spinal surgery involves different techniques and treatment strategies. Intraoperative navigation by 3D tomography (IoCT) is used to facilitate the insertion of pedicular screws. Better accuracy has been demonstrated by several studies when using navigation compared to fluoroscopy. However, no study as far as we know, investigated the operative outcomes of navigation during single-level transforaminal interbody fusion (SL-TLIF). Objectives: Our goal was to evaluate the impact of Computer Assisted Navigation during SL-TLIF in terms of operative time, hospitalization, blood loss and number of surgical revisions up to 6 months postoperatively when compared to fluoroscopic guidance. Methods: This is a retrospective, single center, case-control study. Patients submitted to SL-TLIF between 2016 and 2020 with fluoroscopy (Fluoro) or loCT navigation (Nav) were evaluated. We excluded traumatic, oncological, infectious, minimally invasive cases, anterior and lateral cases and all those performed on more than one level. Demographic, clinical, and surgical data were collected. Results: One hundred and seventy-six patients were included, 54 (30.68%) in the Nav group and 122 (69.32%) in the Fluoro group. A statistically significant difference in operative time (OT) was reported (Nav 185.93 Vs. Fluoro 163.24, p=0.003), with an average OT of 170 min. The revision rate was also significantly different, with 8 revisions of surgery in the Fluoro group and none in the Nav group (6.6% of GF patients, p=0.050). No statistically significant difference was found for blood loss (Nav 270.83 ml vs. Fluoro 277.28 ml p=0.827) and hospitalization time (days) (4.31 for Nav vs. 4.65 for Fluoro p=0.302). Discussion: Despite the increase in operative time in the Nav group, navigation does not involve increased blood loss or longer hospital stay. We observed a lower rate of reoperation in the Nav group during the first 6 months postoperatively. Conclusions: The use of IoCT navigation is safe, effective, and provides advantages even when used to perform single level TLIF.