C-arm free simultaneous OLIF51 and percutaneous pedicle screw fixation in a single lateral position: A technical note

Background: Indirect decompression for lumbar canal stenosis as a technique of minimally invasive surgery (MIS), is receiving considerable attention. Conventional MIS indirect decompression at L5-S1 is performed using intraoperative fluoroscopy. In this work, we describe a novel C-arm free simultaneous MIS indirect decompression technique for L5-S1 pathology. Methods: A 72-year-old woman with symptomatic L5 isthmic spondylolisthesis was referred to our hospital. The patient's daily life had been affected by severe low back pain for 5 years and left leg pain for 2 years. The surgery was performed without C-arm fluoroscopy. The percutaneous pedicle screws and intervertebral cages were inserted only under navigation guidance in a single lateral position. Results: The patient was successfully treated with surgery. Her low back pain and left leg pain improved dramatically. Her clinical outcomes, the Oswestry disability index (ODI) improved from 48% to 14% and the low back pain visual analog scale (VAS) score improved from 78 mm to 23 mm at 1 year of final follow-up. Conclusions: C-arm-free simultaneous MIS indirect decompression for L5-S1 is a useful technique, which may reduce surgical time and blood loss. With this new technique, surgeons and operation room staff can avoid the risk of an adverse event of intraoperative radiation.