The use of intra-operative navigation during complex lumbar spine surgery under spinal anesthesia

Abstract

Background: Spinal anesthesia is a safe and effective alternative to general anesthesia in both simple and complex lumbar surgery with numerous reported advantages leading to increased recent utilization. One potential barrier to the use of spinal anesthesia in lumbar surgery is the popularity of intraoperative computed tomography (CT) imaging. Intraoperative CT necessitates motionless patients and adds time to procedures, issues that may make surgeons hesitant to use concomitant spinal anesthesia. To date, the use of both techniques simultaneously has not been well described. Objective: We propose that single-level lumbar fusions utilizing intraoperative CT scan acquisition and navigated instrumentation are feasible under single-dose spinal anesthesia without detrimental effect on image quality and navigation accuracy or need for spinal anesthetic re-dosing due to the additional time necessary. Methods: We describe operative characteristics and intra-operative timing for our first five cases of transforaminal lumbar interbody fusion (TLIF) completed with intraoperative CT scan acquisition and navigated instrumentation performed under spinal anesthesia. Results: The five patients ranged in age from 59 to 79 years, with an average body mass index of 27.0 kg/m2. The average total operative time for each surgery 109.2 min, including approximately 6.3 min required for CT scan acquisition. There were no complications and post-operative imaging demonstrated no malpositioned pedicle screws. Conclusion: Single-level TLIF procedures utilizing intraoperative CT acquisition and navigated instrumentation can be feasibly completed under single-dose spinal anesthesia without need for intraoperative apneic periods and without deleterious effect on instrumentation accuracy.