Single-Position Extreme Lateral Lumbar Interbody Fusion with Percutaneous Pedicle Screw Fixation Utilizing O-arm Navigation

Objective Extreme lateral interbody fusion (XLIF) provides indirect decompression of the spinal canal and nerve root foramen while preserving the vertebral structures. Intraoperative guidance during conventional XLIF with percutaneous pedicle screw fixation (PPSF) relies primarily on fluoroscopy, which can expose both surgical staff and the patient to radiation. The use of O-arm navigation during XLIF and PPSF is anticipated to improve accuracy and significantly reduce the risk of radiation. Methods Thirty-one XLIF and PPSF procedures were performed using O-arm navigation in a semi-lateral, single-position setup, including 23 single-level and eight two-level cases. Pathologies included 22 lumbar degenerative spondylolisthesis, seven canal stenosis, and two spondylolytic spondylolisthesis. The control group included 29 patients who underwent two-position XLIF with C-arm fluoroscopy. For each patient, we collated key parameters, including operative time, blood loss, JOA score, ODI, and radiation exposure/doses. Patients were placed in a semi-lateral position. PPSF was first performed under O-arm guidance; subsequently, disc preparation and cage insertion were navigation-assisted and verified by C-arm fluoroscopy. Results Operative time and blood loss were similar between the navigation XLIF and non-navigation XLIF groups. The navigation-XLIF group had a much shorter radiation time (13.01 ± 6.56 vs. 66.46 ± 24.62 s) and a lower radiation dose (1.66 ± 0.62 vs. 5.48 ± 3.01 mGy). Both groups showed notable postoperative improvements in JOA and ODI scores. Conclusion XLIF with O-arm navigation demonstrated practicality, reliability, accuracy, precise cage placement, and complication rates comparable to those of traditional methods. Enhanced anatomical visualization reduced radiation exposure among surgical personnel.