Comparative study of O-arm and C-arm guided percutaneous screw placement in unilateral biportal endoscopic transforaminal lumbar interbody fusion

English Keywords:Lumbar interbody fusion  Biportal endoscopy  O-arm navigation

English Abstract:

  【Abstract】 Objectives: To compare and analyze the application of O-arm and C-arm guided percutaneous screw placement in unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF). Methods: A retrospective analysis was made on 50 patients with lumbar degenerative disease treated by UBE-TLIF from January 1, 2020 to September 30, 2020 in our hospital, including 25 males and 25 females, averaged age was 58.9±12.8 years (23-80 years old). The patients were divided into O-arm group(27 cases) and C-arm group(23 cases) according to the technique of Percutaneous pedicle screw placement. The O-arm group consisted of 17 males and 10 females, averaged age was 58.8±14.3 years(23-80 years old), while the C-arm group consisted of 8 males and 15 females, averaged age was 59.0±10.9 years(27-76 years old). The operation time, intraoperative bleeding, postoperative hospital stay, and the accuracy of screw placement [Gertzbein-Robbins (G-R) grading was used to evaluate the accuracy of screw placement 1 week after surgery] were compared between the two groups. The preoperative and 3-month post-operative Oswestry disability index(ODI) and visual analogue scale(VAS) for back and leg pain were evaluated, and 3-month post-operative modified Macnab criteria(Macnab) were used to evaluate the clinical efficacy. Surgical complications and revision rate were compared between the two groups. Results: The average operation time of O-arm group and C-arm group was 196.0±37.5min and 260.9±69.4min, respectively, the difference was statistically significant(P<0.05). The mean bleeding volume was 108.1±149.6ml and 106.5±108.0ml, and the average length of postoperative hospital stays were 5.3±1.7 days and 5.2±1.6 days, respectively. There was no significant difference between the two groups in the mean bleeding volume and the mean length of postoperative hospital stays(P>0.05). Gertzbein Robbins (G-R) grading of the O-arm group was better than that of the C-arm group(P<0.05). The VAS and ODI scores of both groups were significantly improved 3 months after operation compared to those before operation(P<0.05). The modified Macnab criteria were used to evaluate the clinical outcomes after operation, the excellent and good rates of the O-arm group and C-arm group were 93% and 91%, respectively, with astatistically significantdifference(P>0.05). The surgical complication rate of the O-arm group was 7.4%(2/27), and that of the C-arm group was 8.7%(2/23), the difference was not statistically significant(P>0.05). After conservative treatment, the patients recovered and were discharged without revision. Conclusions: Compared with C-arm, the use of O-arm can effectively improve the accuracy of percutaneous screw placement of UBE-TLIF shorten the operation time, and has a good role of auxiliary screw placement.