Simultaneous lateral interbody fusion and pedicle screws (SLIPS) with CT-guided navigation.

OBJECTIVES: The advent of minimally invasive, percutaneous techniques for the placement of pedicle screws has led to the evolution of a popular treatment paradigm: anterior or lateral interbody fusions followed by posterior percutaneous pedicle screw placement. We present the operative technique for anterior-to-psoas lateral interbody fusion (ATP-LIF) with simultaneous posterior lumbar percutaneous pedicle screw fixation using intraoperative CT-guided navigation.

PATIENTS AND METHODS: This technique capitalizes both on the more oblique approach used in the ATP-LIF procedure, as well as the anatomic clarity gleaned from intraoperative CT-guided navigation, to allow for simultaneous placement of pedicle screws in the lateral position without the need for guiding fluoroscopy.

RESULTS: The parallel execution of both procedures, in the lateral position, reduces operative time, consolidates a two-stage procedure into one stage, and eliminates the need for prone re-positioning. The use of intraoperative CT-guided navigation reduces the need for fluoroscopy and overall radiation exposure while allowing for pedicle screw placement and the-LIF procedure in truly simultaneous fashion. In this pilot study, a total of 14 pedicle screws were placed with two lateral breaches (14%).

CONCLUSION: Simultaneous Lateral Interbody and Pedicle Screws (SLIPS) represents a meaningful evolution of the newly reported single-position lateral interbody fusion with posterior percutaneous pedicle screw fixation.