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1.  Minimally invasive percutaneous transpedicular screw fixation: increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system 
Acta Neurochirurgica  2010;153(3):589-596.
Background
Minimally invasive percutaneous pedicle screw instrumentation methods may increase the need for intraoperative fluoroscopy, resulting in excessive radiation exposure for the patient, surgeon, and support staff. Electromagnetic field (EMF)-based navigation may aid more accurate placement of percutaneous pedicle screws while reducing fluoroscopic exposure. We compared the accuracy, time of insertion, and radiation exposure of EMF with traditional fluoroscopic percutaneous pedicle screw placement.
Methods
Minimally invasive pedicle screw placement in T8 to S1 pedicles of eight fresh-frozen human cadaveric torsos was guided with EMF or standard fluoroscopy. Set-up, insertion, and fluoroscopic times and radiation exposure and accuracy (measured with post-procedural computed tomography) were analyzed in each group.
Results
Sixty-two pedicle screws were placed under fluoroscopic guidance and 60 under EMF guidance. Ideal trajectories were achieved more frequently with EMF over all segments (62.7% vs. 40%; p = 0.01). Greatest EMF accuracy was achieved in the lumbar spine, with significant improvements in both ideal trajectory and reduction of pedicle breaches over fluoroscopically guided placement (64.9% vs. 40%, p = 0.03, and 16.2% vs. 42.5%, p = 0.01, respectively). Fluoroscopy time was reduced 77% with the use of EMF (22 s vs. 5 s per level; p < 0.0001) over all spinal segments. Radiation exposure at the hand and body was reduced 60% (p = 0.058) and 32% (p = 0.073), respectively. Time for insertion did not vary between the two techniques.
Conclusions
Minimally invasive pedicle screw placement with the aid of EMF image guidance reduces fluoroscopy time and increases placement accuracy when compared with traditional fluoroscopic guidance while adding no additional time to the procedure.
doi:10.1007/s00701-010-0882-4
PMCID: PMC3040822  PMID: 21153669
Minimally invasive; Electromagnetic field navigation; Pedicle screw; Fluoroscopy; Accuracy
2.  Quality-of-Life Outcomes With Minimally Invasive Transforaminal Lumbar Interbody Fusion Based on Long-Term Analysis of 304 Consecutive Patients 
Spine  2014;39(3):E191-E198.
Long-term prospective outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) is not well studied. This article is a prospective clinical study to examine short-/long-term outcomes of 304 patients undergoing MITLIF. There were statistically significant clinical outcomes after MITLIF surgery, including spinal fusion and decreased postoperative complications.
Study Design.
This was a prospective clinical study that took place in an outpatient spine clinic.
Objective.
To demonstrate the short-/long-term outcomes from a large cohort of patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF).
Summary of Background Data.
Long-term prospective outcomes in patients undergoing minimally invasive spinal fusion for debilitating back pain has not been well studied.
Methods.
Presenting diagnosis was determined from clinical findings and radiographical (radiograph, magnetic resonance image, computed tomographic scan) evaluations preoperatively. Patients were assessed with outcome measures preoperatively, and postoperatively at 2 weeks, 3 months, 6 months, 12 months, 24 months, and annually 2 to 7 years (mean follow-up: 47 mo) final follow-up. The rate of postoperative complications and reoperations at the initial level of MITLIF and adjacent level(s) were followed. Fusion rates were assessed blinded and independently by radiograph.
Results.
Visual analogue scale scores decreased significantly from 7.0 preoperatively to 3.5 at mean 47-month follow-up. Oswestry Disability Index scores declined from 43.1 preoperatively to 28.2 at mean 47-month follow-up. Short-Form 36 mental component scores increased from 43.8 preoperatively to 49.7 at 47-month follow-up. Short-Form 36 physical component scores increased from 30.6 preoperatively to 39.6 at 47-month follow-up (P < 0.05).
Conclusion.
This prospectively collected outcomes study shows long-term statistically significant clinical outcomes improvement after MITLIF in patients with clinically symptomatic spondylolisthesis and degenerative disc disease with or without stenosis. MITLIF resulted in a high rate of spinal fusion and very low rate of interbody fusion failure and/or adjacent segment disease requiring reoperation while reducing postoperative complications.
Level of Evidence: 3
doi:10.1097/BRS.0000000000000078
PMCID: PMC4047299  PMID: 24150437
lumbar fusion; minimally invasive spine surgery; minimally invasive transforaminal; lumbar interbody fusion, percutaneous pedicle screws; patient outcomes

Results 1-2 (2)