Instrument Tracking Reduces Radiation Exposure and Increases Efficiency in Prone Lateral Lumbar Interbody Fusion: A Retrospective Cohort Study

BACKGROUND: Minimally invasive spine surgery, particularly lateral lumbar interbody fusion, offers advantages over open surgery, including reduced blood loss and shorter hospital stays. The prone lateral lumbar interbody fusion (PL-LIF) is an evolution of lateral lumbar interbody fusion that enables posterior instrumentation without repositioning, enhances sagittal correction, and may improve operative efficiency. However, concerns remain regarding prolonged psoas retraction and increased radiation exposure. While instrument tracking technologies have improved workflow and reduced radiation in other minimally invasive surgeries, such as minimally invasive transforaminal lumbar interbody fusion, their role in PL-LIF remains unstudied. This study evaluates the impact of instrument tracking on psoas retraction time, radiation exposure, and procedural efficiency in PL-LIF. METHODS: A retrospective analysis reviewed PL-LIF procedures using instrument tracking technology at a single institution over 7 months. Operative times (minutes), radiation exposure (mGy and number of x-ray images), and patient-reported outcome measures (PROMs) were analyzed. The dataset was divided into temporal quartiles based on the chronological order of surgical cases to evaluate the impact of learning over time. PROMs were also reported. RESULTS: < 0.001). CONCLUSIONS: Prolonged retractor times and substantial radiation associated with the PL-LIF can be dramatically reduced with instrument tracking. Intraoperative radiation exposure was significantly reduced compared with previous studies, with a minimal number of x-rays images required from study onset. Psoas retraction time significantly decreased after an inflection point at 15 cases, ultimately falling below 15 minutes and correlating with adherence to the recommended 20-minute threshold in 85% of cases during the final quartile. Instrument tracking can substantially decrease retractor time and radiation exposure in PL-LIF. CLINICAL RELEVANCE: Instrument tracking in PL-LIF improves efficiency and safety, reducing psoas retraction time and radiation while maintaining 12-month PROM gains.