The Importance of Planning Ahead: A Three-Dimensional Analysis of the Novel Trans-Facet Corridor for Posterior Lumbar Interbody Fusion Using Segmentation Technology.
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2024-05
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Abstract
Background
The rise of minimally invasive lumbar fusions and advanced imaging technologies has facilitated the introduction of novel surgical techniques with the trans-facet approach being one of the newest additions. We aimed to quantify any pathology-driven anatomic changes to the trans-facet corridor, which could thereby alter the ideal laterality of approach to the disc space.Methods
In this retrospective cohort study, we measured the areas and maximum permissible cannula diameters of the trans-facet corridor using commercially available software (BrainLab, Munich, Germany). Exiting and traversing nerve roots, thecal sacs, and lumbar vertebrae were manually segmented on T2-SPACE magnetic resonance imaging. Spondylolisthesis, disc protrusions, and disc space heights were recorded.Results
A total of 118 trans-facet corridors were segmented bilaterally in 16 patients (65.6 ± 12.1 years, 43.8% female, body mass index 29.2 ± 5.1 kg/m2). The mean areas at L1-L2, L2-L3, L3-L4, and L4-L5 were 89.4 ± 24.9 mm2, 124 ± 39.4 mm2, 123 ± 26.6 mm2, and 159 ± 42.7 mm2, respectively. The mean permissible cannula diameter at the same levels were 7.85 ± 1.43 mm, 8.98 ± 1.72 mm, 8.93 ± 1.26 mm, and 10.2 ± 1.94 mm, respectively. Both parameters increased caudally. Higher degrees for spondylolisthesis were associated with larger areas and maximum cannula diameters on regression analysis (P < 0.001).Conclusions
Our results illustrate that pathology, like spondylolisthesis, can increase the area of the trans-facet corridor. By understanding this effect, surgeons can better decide on the optimal approach to the disc while taking into consideration a patient's unique anatomy.Type
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Tabarestani, Troy Q, Peter N Drossopoulos, Chuan-Ching Huang, Alyssa M Bartlett, Mounica R Paturu, Christopher I Shaffrey, John H Chi, Wilson Z Ray, et al. (2024). The Importance of Planning Ahead: A Three-Dimensional Analysis of the Novel Trans-Facet Corridor for Posterior Lumbar Interbody Fusion Using Segmentation Technology. World neurosurgery. p. S1878-8750(24)00854-4. 10.1016/j.wneu.2024.05.091 Retrieved from https://hdl.handle.net/10161/31235.
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Scholars@Duke
Courtney Rory Goodwin
Associate Professor of Neurosurgery, Radiation Oncology, Orthopedic Surgery.
Director of Spine Oncology,
Associate Residency Program Director
Third Year Study Program Director Neurosciences, Duke University School of Medicine
Director of Spine Metastasis, Duke Center for Brain and Spine Metastasis, Department of Neurosurgery
Duke Cancer Institute, Duke University Medical Center
Timothy James Amrhein
Dr. Amrhein is an Associate Professor in the Department of Radiology at Duke University Medical Center where he also serves as the Director of Spine Intervention. He completed residency training in Diagnostic Radiology at Duke, where he served as chief resident, and stayed to complete a Neuroradiology fellowship.
Muhammad Abd-El-Barr
As a Neurosurgeon with fellowship training in Spine Surgery, I have dedicated my professional life to treating patients with spine disorders. These include spinal stenosis, spondylolisthesis, scoliosis, herniated discs and spine tumors. I incorporate minimally-invasive spine (MIS) techniques whenever appropriate to minimize pain and length of stay, yet not compromise on achieving the goals of surgery, which is ultimately to get you back to the quality of life you once enjoyed. I was drawn to medicine and neurosurgery for the unique ability to incorporate the latest in technology and neuroscience to making patients better. I will treat you and your loved ones with the same kind of care I would want my loved ones to be treated with. In addition to my clinical practice, I will be working with Duke Bioengineers and Neurobiologists on important basic and translational questions surrounding spinal cord injuries (SCI), which we hope to bring to clinical relevance.
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