Oblique Lateral Interbody Fusion with Posterior Instrumentation in the Lateral Position Using Free-hand Technique and Custom-length Trocar: A Technical Note

Abstract Background: Minimally invasive spine surgery has gained widespread adoption due to its benefits. However, intraoperative fluoroscopy remains essential for accurate localization. This study introduces a method for percutaneous screw placement that utilizes a controlled anterior-posterior (AP) fluoroscopic trajectory, providing a structured approach to instrumentation while maintaining procedural precision. Objectives: The objective of the study was to describe a feasible technique for pedicle screw placement using single-plane fluoroscopy and a custom-length trocar. Materials and Methods: This technical note describes the procedural steps of single-position oblique lateral interbody fusion with posterior instrumentation (PI) performed using single-plane fluoroscopy and a custom-length trocar. The technique has been applied at our institution since January 2022. Key intraoperative steps, fluoroscopic alignment, and instrument design are detailed to illustrate its practical application. Results: The described technique employs single-plane fluoroscopy and a custom-length trocar to guide pedicle screw placement along an AP trajectory. This approach reduces the need for lateral fluoroscopic views and minimizes C-arm repositioning. The trocar design, based on pedicle morphology, assists in aligning instrumentation and maintaining a consistent screw trajectory during free-hand insertion. Conclusions: This technique uses single-plane fluoroscopy and a custom-length trocar to guide pedicle screw placement in a single-position approach. It allows consistent instrument alignment with reduced reliance on lateral imaging, supporting its feasibility for PI without repositioning.