Navigation-Assisted Unilateral Biportal Endoscopic Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis: A Retrospective Cohort Study of Workflow Efficiency and Fluoroscopic Burden
This retrospective cohort study demonstrates that navigation-assisted unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) significantly reduces total operative time and fluoroscopic radiation exposure compared to conventional fluoroscopy-guided techniques, primarily by accelerating percutaneous instrumentation, without showing a consistent advantage in 12-month clinical or radiographic outcomes.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Back pain that radiates down the leg, often caused by a vertebra slipping out of place, can be a debilitating condition that resists standard treatments like physical therapy or medication. When the spine becomes unstable, surgeons often turn to a procedure called fusion, where they join two vertebrae together to stop the painful movement. One modern approach, known as unilateral biportal endoscopic transforaminal lumbar interbody fusion, or UBE-TLIF, uses two small incisions and a tiny camera to remove damaged tissue and insert a spacer between the bones. This method is less invasive than traditional open surgery, but it presents a unique challenge: the surgeon is working through a narrow tunnel with a camera, making it difficult to see the exact three-dimensional position of the spine and the tools. To navigate this, surgeons typically rely on a C-arm machine that takes X-ray images, similar to a video camera but using radiation, to check their position repeatedly throughout the operation. This constant checking can be time-consuming and exposes both the patient and the medical team to radiation.
A team of researchers at Qilu Hospital of Shandong University set out to see if a new tool could make this delicate procedure faster and safer. They compared the standard method, which relies on frequent X-ray checks, against a system that uses a digital navigation guide. This navigation system works by taking two standard X-ray pictures at the start of the surgery to create a digital map of the patient's spine. Once this map is set, the system tracks the surgeon's tools in real time, showing their exact location on a screen without needing to take new X-rays for every step. The researchers wanted to know if this digital guidance would save time, reduce the amount of radiation used, and improve the final outcome for patients suffering from a slipped vertebra.
The study looked at nearly one hundred adults who underwent this single-level fusion surgery between early 2023 and mid-2025. The patients were divided into two groups: one group was treated using the traditional method of frequent X-ray checks, while the other group used the new optical navigation system. The researchers measured everything from how long the surgery took to how many X-ray images were needed, and they followed the patients for a full year to see how their pain and ability to move improved. The results showed a clear difference in the speed of the operation. The group using the navigation system finished their surgeries in an average of about 157 minutes, whereas the group using the traditional X-ray method took an average of about 201 minutes. This means the navigation group saved roughly 44 minutes per operation. The biggest time savings occurred when the surgeons were placing the screws and rods through the skin, a step that usually requires many X-ray checks to ensure the metal is in the right spot. With the navigation system, the surgeons could see the tool's path on a screen, allowing them to place the hardware much more quickly and with fewer interruptions.
Perhaps even more significant was the reduction in radiation exposure. The traditional group required an average of nearly 43 X-ray images during the surgery to guide the placement of screws and cages. In contrast, the navigation group needed only about 8 images on average. This dramatic drop meant the estimated radiation dose for the navigation group was roughly 17 units, compared to nearly 86 units for the traditional group. The researchers noted that the navigation system did not eliminate X-rays entirely; it simply shifted their use from constant, repetitive checking to a single setup at the beginning and a few final checks. This change significantly lowered the cumulative radiation burden for everyone in the operating room.
Despite these clear advantages in speed and safety regarding radiation, the study found that the two methods produced very similar results for the patients themselves. By the one-year mark, both groups reported similar levels of pain relief, similar improvements in their ability to walk and perform daily tasks, and similar rates of successful bone healing. The accuracy of the screw placement was high in both groups, and the number of complications, such as infections or nerve issues, was low and comparable between the two methods. The researchers concluded that while the navigation system did not make the patients feel significantly better in the long run compared to the traditional method, it made the surgery itself much more efficient. It allowed the surgeons to work faster and with far less radiation, suggesting that the primary value of this technology lies in optimizing the workflow of the operation rather than changing the final clinical outcome for the patient.
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