Minimally invasive spine surgery using the X-tube and SEXTANT system with Iso-C navigation

摘要

Introduction: It was often that spinal operations navigation system was used for the safety implantingl). We did minimally invasive spine surgery (MIS) for the lumbar spinal canal stenosis since 2001. The SEXTANT (Medtronic Sofa-more Danek; MSD) is percutaneous pedicle screwing and roding system for the MIS. We can use that in Japan since 2005. We evaluated that the spinal surgery navigation system was useful or not for the SEXTANT MIS. Methods: Since October 2005, 78 cases operations were performed with X-tube (tube retractor by MSD) and SEXTANT system. Reference for the Vector Vision compact (Brain LAB) was put on the rostal spinous process by 3mm K-wire, usually L2 and L3. Then SIREMIBIL Iso-C 3D (Siemens) exposure was performed. We did unilateral approach for the bilateral decompression through X-tube. At that time, we can get the information from navigation where am I. We check the decompression by the navigation and microendoscopy system. Then, we put pedicle screw to opposite site pedicle percutaneously with preca-libration navigation instruments. And sometimes we use fluoroscopy together. The SEXTANT system is very elaborate design. We need insert the implants accurately. We remove the lesion disc and put into the Telamon-MIS (MSD) cage with local bone. At last, we put the screw and rod in the same way as the opposite side. We put the drain into the wound for protect of epidural hematoma. The 48 males and 30 females were operated with these MIS-PLIF procedures. Average age was 66.2 years old. We evaluated operation time, blood loss, fluo-roscopic time, clinical results include SF-36, and surgeons feeling what is useful intraoperatively.