Effect of computer navigation-assisted minimally invasive direct lateral interbody fusion in the treatment of patients with lumbar tuberculosis: A retrospective study

Surgical Management of Spinal Tuberculosis-The Past, Present, and Future

Tuberculosis is endemic in many parts of the world. With increasing immigration, we can state that it is prevalent throughout the globe. Tuberculosis of the spine is the most common form of bone and joint tuberculosis; the principles of treatment are different; biology, mechanics, and neurology are affected. Management strategies have changed significantly over the years, from watchful observations to aggressive debridement, to selective surgical indications based on well-formed principles. This has been possible due to the development of various diagnostic tests for early detection of the disease, effective anti-tubercular therapy, and associated research, which have revolutionized treatment. This picture is rapidly changing with the advent of minimally invasive spine surgery and its application in treating spinal infections. This review article focuses on the past, present, and future principles of surgical management of tuberculosis of the spine.

Overview of Minimally Invasive Spine Surgery

Minimally invasive spine surgery (MISS) has continued to evolve over the past few decades, with significant advancements in technology and technical skills. From endonasal cervical approaches to extreme lateral lumbar interbody fusions, MISS has showcased its usefulness across all practice areas of the spine, with unique points of access to avoid pertinent neurovascular structures. Adult spine deformity has also recognized the importance of minimally invasive techniques in its ability to limit complications and to provide adequate sagittal alignment correction and improvements in patients' functional status. Although MISS has continued to make significant progress clinically, consideration must also be given to its economic impact and the learning curve surgeons experience in adding these procedures to their armamentarium. This review examines current innovations in MISS, as well as the economic impact and future directions of the field.

Computer Navigation in Minimally Invasive Spine Surgery

PURPOSE OF REVIEW

The goal of the review is to discuss the common general applications of navigation in the context of minimally invasive spine surgery and assess its value in the published literature comparing against non-navigated or navigated techniques.

RECENT FINDINGS

There is increasing utilization of computer navigation in minimally invasive spine surgery. There is synergy between navigation and minimally invasive technologies, such that one enhances or facilitates the other, thus leading to wider applications for both. Specifically, navigation has been shown to improve performance of percutaneous pedicle screw placement, vertebral augmentation, and minimally invasive fusion procedures. Overall, clinical studies have shown better accuracy and less radiation exposure with the use of navigation in spine surgery. The use of navigation in minimally invasive spine surgery enhances the accuracy of instrumentation and decreases radiation exposure. It is yet to be determined whether patient-reported outcomes will differ. Further research on its effect on clinical outcomes may further define the future impact of navigation in minimally invasive spine surgery.