AnnualForum’19 LAS VEGAS, NEVADA | OCT. 31–NOV. 2, 2019 ONLINE PROGRAM BOOK Abstracts AnnualForum’19 LAS VEGAS, NEVADA | OCT. 31–NOV. 2, 2019 Abstracts AnnualForum’19 2ANNUAL FORUM ’19 | LAS VEGAS, NEVADA | OCT. 31–NOV. 2, 2019 Paper #1: FDA Trial of Paraspinous Tension Band for Degenerative Spondylolisthesis: Preliminary Safety and Outcomes in 100 Subjects with 6-Months Follow-up Paper #2: Simultaneous Lateral Interbody Fusion with Robot Assisted Pedicle Screw Fixation in Single Position: Seven Consecutive Cases from a Large Volume Center Paper #3: Improved Bone-Removal Using a New Device in Open and Minimal Invasive Approaches: A 2-Center Experience with 143 Patients Paper #4 Stem Cell Injections for Axial Back Pain: A Systematic Review of Associated Risks and Complications with Case Illustration of Diffuse Hyperplastic Gliosis Resulting in Cauda Equina Syndrome Paper #5: Minimally Invasive TLIF with Expandable Articulating Interbody Spacers Significantly Improves Radiographic Outcomes Compared to Static Interbody Spacers Paper #6: Comparative Effectiveness of Minimally Invasive Bilateral Transforaminal Lumbar Interbody Fusions Using 2 Intervertebral Titanium Expandable Versus Peek Static Interbody Spacers: 1-year Radiographic Outcomes Paper #7: Implementation of Enhanced Recovery After Surgery (ERAS) Program for Patients Undergoing Same Day Outpatient Elective Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS TLIF) Paper #8: Virtual/Mixed Reality Technologies for Minimally Invasive and Complicated Spinal Surgery Paper #9: Navigated Robotic Assistance Improves Pedicle Screw Accuracy In Minimally Invasive Surgery of the Lumbosacral Spine: 600 Pedicle Screws in a Single Institution Paper #10: Combining Technologies— Robotic-Assisted Endoscopic Transforaminal Lumbar Interbody Fusion Paper #11: Surgical Testing Comparison of Single Position Robot-Assisted Navigation Versus Conventional MIS Bilateral Screw Trajectory During LLIF Procedure: An In-vitro Study Paper #12: Cervical Pedicle Screw Insertion Using O-Arm-Based 3D Navigation: Technical Advancement to Improve Screw Accuracy Paper #13: Radiation Reduction Using Image Enhancement Technology Better Than ALARA Practice Alone In Lateral, Single-Position Lumbar Surgery Paper #14: Surgeons’ Intraoperative Radiation Exposure in Single- and Multi-level Minimally Invasive Transforaminal Lumbar Interbody Fusion Paper #15: A Review of Time-Demand, Radiation Exposure and Outcomes of Skin-Anchored Intraoperative 3D Navigation in Minimally Invasive Lumbar Spinal Surgery CONCURRENT SESSION 2A: EMERGING & NAVIGATION FREE PAPERS Table of ContentsAbstracts AnnualForum’19 3ANNUAL FORUM ’19 | LAS VEGAS, NEVADA | OCT. 31–NOV. 2, 2019 Paper #16: Defining MIS TLIF: A Systematic Review of Techniques and Technologies Used by Surgeons Worldwide Paper #17: A Comparison of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Grade 1 Degenerative Lumbar Spondylolisthesis: An Analysis of the Prospective, Quality Outcomes Database Paper #18: The Impact of Comorbidity Burden on Postoperative PROMIS Physical Function Following Minimally Invasive Transforaminal Lumbar Interbody Fusion Paper #19: Does Minimally Invasive Anterior- Posterior Lateral Position Surgery Deteriorate Clinical Outcome and Spinal Alignment for Lumbar Spondylolisthesis Versus MIS TLIF? Paper #20: Single Position Anterior-Posterior Lumbar Fusion Improves Perioperative Outcomes and Reduces Complications Compared to Traditional Anterior-Posterior Lumbar Fusion Paper #21: Clinical Results of Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion: A New Modified Technique for Treating Degenerative Lumbar Spondylolisthesis Paper #22: A New Groove-Entry Technique for Inserting Thoracic Percutaneous Pedicle Screws Paper #23: The Use of Bone Morphogenetic Protein in the Intervertebral Disk Space in Minimally Invasive Transforaminal Lumbar Interbody Fusion: 10-year Experience in 688 Patients Paper #24: Multi-Level Stenosis and Deformity of Spine: When Is a Only Microsurgical Approach Indicated? Paper #25: Preliminary 24-month Outcomes of a Prospective Investigation of a Novel Mesh Interbody Spacer in Single-level Fusions Paper #26: Single-Level Controlled Comparison of OLIF51 and PPS in Lateral Position Versus MIS TLIF for Lumbosacral Degenerative Disorders: Clinical and Radiologic Study Paper #27: Patients Receiving Nonsurgical Management for Sacroiliitis Diagnosed with Intra-Articular Injection Report Positive Outcomes at Long-term Follow-up Paper #28: Comparison of Clinical and Radiological Results Using Uniportal Versus Biportal Endoscopic Discectomy for Single-Level Lumbar Disc Herniation Paper #29: Does Degenerative Spondylolisthesis Require Instrumented Fusion? Unilateral Laminotomy for Bilateral Decompression Versus Posterior Decompression with Fusion at 5-Year Follow-up Paper #30: Clinical Efficacy and Safety of Trans-Sacral Epiduroscopic Laser Decompression Compared to Percutaneous Epidural Neuroplasty CONCURRENT SESSION 2B: DEGENERATIVE & POSTERIOR FREE PAPERS Abstracts AnnualForum’19 4ANNUAL FORUM ’19 | LAS VEGAS, NEVADA | OCT. 31–NOV. 2, 2019 Paper #31: An Intraoperative Radiographic Assessment Method for Evaluating Indirect Decompression in Oblique Lumbar Interbody Fusion Paper #32: Early Radiological & Clinical Outcomes of Minimally Invasive Oblique Lumbar Interbody Fusion in Degenerative Lumbar Spine Disorders in Indian Population. Paper #33: Delayed Neurologic Deficit in Post OLIF Surgery Patient: Easy to Miss Findings on Images Paper #34: Utility of Intraoperative Motor- Evoked Potential During L4-5 Direct Transpsoas Lateral Interbody Fusion to Avoid Nerve Injury Paper #35: Percutaneous Transforaminal Lumbar Interbody Fusion with Expandable Cage Through Kambin’s Triangle: Initial Results and Feasibility Paper #36: A Radiographic Analysis of Segmental Sagittal Correction Following Interbody Fusion Through an Antepsoas Approach Paper #37: Predictive Machine Learning Algorithm to Calculate Probability of Developing Subsidence After Lateral Lumbar Interbody Fusion Paper #38: When Indirect Decompression Fails: A Prospectively Collected Series of Patients Requiring Secondary Direct Decompression After Lateral Interbody Fusion Paper #39: Novel MIS 3D NAV Single Step Pedicle Screw System: Workflow, Accuracy, and Initial Clinical Experience Paper #40: Accuracy of Percutaneous Pedicle Screw Placement in Minimally Invasive Spine Surgery: Fluoroscopic Guidance Versus 3D-Navigation Paper #41: Endoscopic Decompression of Epidural Spinal Metastasis Causing Lumbar Radiculopathy Through a Transforaminal Approach: Report of 2 Cases Paper #42: Percutaneous Endoscopic Transforaminal Interbody Fusion Through Bi-Portal Technique Paper #43: What PROMIS Scores Correlate with Severe Disability in Cervical Spine Surgery? Paper #44: Two-Year Retrospective Bayesian Assessment of Cervical Artificial Disc Replacement Failure Factors Paper #45: The Impact of NSAID Use After Lumbar Fusion Surgery on Fusion Rate and Complications: A Meta-Analysis Paper #46: Preoperative Opioid Use and Postoperative Pain in Patients Undergoing Minimally Invasive Stand-Alone Lateral Lumbar Interbody Fusion Paper #46b: Lumbar Microdecompression in Elderly Versus General Adult Patients: Comparable Outcomes Despite Group Differences CONCURRENT SESSION 2C: YOUNG SURGEONS’ FREE PAPERSAbstracts AnnualForum’19 5ANNUAL FORUM ’19 | LAS VEGAS, NEVADA | OCT. 31–NOV. 2, 2019 Paper #47: Reoperation and Complication Rates After Strategic Circumferential Minimally Invasive Surgical (cMLS) Correction of Adult Spinal Deformities (ASD): A 7-Year Study Paper #48: Revision Surgery Rates in Patients Undergoing Minimally Invasive Adult Spinal Deformity Surgery: Is There a Correlation with Roussouly Spine Type? Paper #49: Are The New Strategic Circumferential Minimally Invasive Surgical Techniques a Safe and Effective Approach for Correction of Adults Spinal Deformity in Elderly Patients? Paper #50: The Minimally Invasive Interbody Selection Algorithm for Spinal Deformity Paper #51: A Prospective Analysis of Minimally Invasive Surgery for Adult Spinal Deformity: A Multicenter Study Paper #52: Treatment of Adult Scoliosis Fractional Curve with Minimally Invasive Surgery: Anterior Versus Posterior Approach? Paper #53: Does ACR Result in Greater Morbidity Than LLIF Alone When Treating Adult Spinal Deformity? Paper #54: Coronal Balance in Degenerative Scoliosis Treated with Minimally Invasive Spinal Deformity Surgery: Are We Leaning in the Right Direction? Paper #55: Radiographic and Surgical Outcome Analysis of Lenke 1a Adolescent Idiopathic Scoliosis Correction: Open Vs. Minimally Invasive Paper #56: Minimally Invasive Surgical Technique for Treatment of Cervical Spondylolytic Myelopathy and Radiculopathy Paper #57: Therapeutic Comparison of Endoscopic Spine Surgery Versus Anterior Cervical Decompression and Fusion for Cervical Spondylotic Myelopathy Paper #58: Can Multilevel Standalone Cervical Fusion Replace Multilevel Plating in Outpatient Setting Paper #59: Does Improved Radiographic Alignment Truly Enhance Dynamic Functional Balance? Paper #60: The Effect of Duration of Symptoms on Clinical Outcomes Following Anterior Cervical Discectomy and Fusion Paper #61: Outcomes and Predictors of Failure to Improve Following Unilateral Laminotomy with Bilateral Decompression CONCURRENT SESSION 8A: DEFORMITY & CERVICAL FREE PAPERSAbstracts AnnualForum’19 6ANNUAL FORUM ’19 | LAS VEGAS, NEVADA | OCT. 31–NOV. 2, 2019 Paper #62: Lateral Access Window for ALIF at L5-S1: Anatomical Measurements to Aid Safety and Feasibility Paper #63: Comparative Effectiveness of Adjustable Lordotic Expandable Versus Static Lateral Lumbar Interbody Fusion Devices: Two Year Clinical and Radiographic Outcomes Paper #64: Laterally Placed Expandable Interbody Spacers Improve Radiographic and Clinical Outcomes: A Two-Year Follow-up Study Paper #65: Determinants of Indirect Decompression in Lateral Lumbar Interbody Fusion Paper #66: The Role of Osteobiologics in Posterior Spinal Fusion Surgery— Do Cellular- Based Allografts Perform As Well As Autografts? Paper #67: Titanium Implants Manufactured with Proprietary 3D-Printing Build Themes Contain Surface Features That Increase Biologic Activity Paper #68: Cost-Effectiveness of Microdiscectomy Versus Endoscopic Discectomy for Lumbar Disc Herniation Paper #69: Combined Nucleus Pulposus Augmentation and Annulus Fibrosus Repair Prevents Intervertebral Disc Degeneration After Experimental Discectomy Paper #70: Lost to Follow-Up in Minimally Invasive Lumbar Spine Surgery Best Paper Award Finalist Paper #71: The Economic Impact of Non- Reimbursable Events in Open, Minimally Invasive, and Robot- Assisted Lumbar Fusion Surgery Paper #72: Return to Activities and Discontinuation of Narcotics After Minimally Invasive Lumbar Spine Surgery Paper #73: Minimally Invasive Surgery in Developing World: An Indigenous Approach to Avoid Economic Burden Best Paper Award Finalist Paper #74: A Prospective, In-Depth Analysis of Perioperative Anterior Thigh Symptoms Associated with a Direct Lateral Access Approach for Lumbar Interbody Fusion Paper #75: Comparative Analysis of Vascular Anatomy in OLIF51 Surgery By Using MRI and Intraoperative Enhanced CT Paper #76: Psoas Muscle Mass are Maintained and No Progress of Fatty Degeneration After LLIF CONCURRENT SESSION 8B: LATERAL, BIOLOGICS & HEALTHCARE ECONOMICS FREE PAPERSAbstracts AnnualForum’19 7ANNUAL FORUM ’19 | LAS VEGAS, NEVADA | OCT. 31–NOV. 2, 2019 Paper #77: The Effect of Surgical Decompression and Fusion on Balance in Patients with Degenerative Lumbar Spondylolisthesis Paper #78: Rate of Fusion in Minimally Invasive Transforaminal Lumbar Interbody Fusion Paper #79: Early Failures After Lumbar Discectomy Surgery: An Analysis of Readmissions and Reoperations in 62,690 Patients Paper #80: Minimally Invasive Decompression Without Instrumentation for Lumbar Spondylolisthesis Paper #81: Characterization and Rate of Symptomatic Adjacent Segment Disease following Index Extreme Lateral Interbody Fusion: A Single-institution, Multi-surgeon Analysis Paper #82: What is the Learning Curve for Endoscopic Microdiscectomy? Paper #83: Extreme Lateral Lumbar Interbody Fusion (XLIF) in Management of Adult Degenerative Scoliosis: A Retrospective Study. Paper #84: Indirect Decompression for Treatment of Degenerative Lumbar Stenosis Paper #85: Minimal Clinically Important Difference and Substantial Clinical Benefit Using PROMIS CAT in Cervical Spine Surgery Paper #86: Does Positioning of Cervical Disc Arthroplasty Implant Affect Postoperative Outcome Paper #87: Does Neck Pain, Function, or Range of Motion Differ After Anterior Cervical Fusion, Cervical Disc Replacement, and Posterior Cervical Foraminotomy? Paper #88: Additional Fusion Surgery After Anterior Cervical Discectomy and Fusion Versus Posterior Foraminotomy for Cervical Disc Herniation Without Myelopathy Paper #89: Comparison of Biomechanical Stability and Rod Strain Between Anterior Column Alignment and Pedicle Subtraction Osteotomy Paper #90: Assessing Correlation Between Radiographic and Intraoperative Electrophysiological Monitoring Findings Consistent with Nerve Root Encroachment for Adult Spine Patients Undergoing Elective Sacroiliac Fusion Paper #91: How Does Minimally Invasive Lumbar Decompression Surgery Impact Lumbar Muscle Health? Paper #92: Electrospun Synthetic Bone Graft Promotes Stem Cell Function and Spinal Fusion Paper #93: The Incremental Cost of Increasing Surgical Technology in Lumbar Spine Fusion Surgery Paper #94: Results of a Pilot Study to Characterize Pre-Operative and Post-Operative Opioid Use in Spine Clinic Patients Best Paper Award Finalist Paper #95: Intravenous Ketorolac Substantially Reduces Opioid Use Following Lumbar Spinal Fusion: Early Results of a Randomized, Double- Blinded, Placebo Controlled Trial CONCURRENT SESSION 8C: YOUNG SURGEON FREE PAPERS Abstracts AnnualForum’19 8ANNUAL FORUM ’19 | LAS VEGAS, NEVADA | OCT. 31–NOV. 2, 2019 Paper #1: FDA Trial of Paraspinous Tension Band for Degenerative Spondylolisthesis: Preliminary Safety and Outcomes in 100 Subjects with 6-Months Follow-up Hyun Bae 1 ; Ivan Cheng, MD 2 ; Rick Sasso, MD 3 ; Alan Villavicencio 4 ; William F. Lavelle, MD 5 ; Timothy Yoon, MD 6 ; Ravi Bains, MD 7 ; Kuo Calvin, MD 7 ; Kim Kee, MD 8 ; Harvinder Sandhu, MD 9 ; Michael Stauff, MD 10 ; Khalid Sethi, MD 11 ; Jeff Fischgrund, MD 12 ; William Welch, MD 13 ; Reginald Davis, MD 14 ; Elizabeth Yu, MD 15 ; Harel Deutsch, MD 16 ; Sigurd Berven, MD 17 ; Matthew Mermer, MD 18 ; Umesh Metkar, MD 19 ; Ammar Hawasli, MD 20 ; Dennis Crandall, MD 21 ; Todd Alamin, MD 22 ; Richard Tallarico, MD 23 ; and Rick Guyer, MD 24 Cedars-Sinai Medical Center, Los Angeles, CA 1 ; Stanford, Palo Alto, CA 2 ; Indiana Spine Group, Carmel, IN 3 ; Boulder Neurosurgical Associates, Boulder, CO 4 ; SUNY Upstate Medical University, Syracuse, NY 5 ; Emory University, Atlanta, GA 6 ; Kaiser Permanente, Oakland, CA 7 ; UC Davis, Sacramento, CA 8 ; Hospital for Special Surgery, New York, NY 9 ; University of Massachusetts, Worcester, MA 10 ; UHS Hospitals- Binghamton, Binghamton, NY 11 ; Beaumont Hospital, Royal Oak, MI 12 ; University of Pennsylvania, Philadelphia, PA 13 ; BioSpine Institute, Tampa, FL 14 ; The Ohio State University Wexner Medical Center, Columbus, OH 15 ; Rush University, Chicago, IL 16 ; UCSF, San Francisco, CA 17 ; Permanente Medical, Roseville, CA 18 ; Beth Israel Deaconess Medical Center, Boston, MA 19 ; Washington University School of Medicine, St Louis, MO 20 ; Sonoran Spine, Tempe, AZ 21 ; Stanford University, Palo Alto, CA 22 ; SUNY Upstate Medical Center, Syracuse, NY 23 ; and Texas Back Institute, Plano, TX 24 Introduction: Degenerative spondylolisthesis (DS) with lumbar spinal stenosis (LSS) is commonly treated with decompression and fusion. The LimiFlex Paraspinous Tension Band (PTB; Empirical Spine, San Carlos, CA) is an alternative stabilization technique for patients with DS and LSS. Aims/Objectives: The purpose of this study is to assess the operative safety and short-term outcomes of PTB compared to transforaminal lumbar interbody fusion (TLIF) for patients with DS and LSS. Methods: Patients undergoing decompression for single- level Grade 1 DS with LSS were enrolled in the open-label, multicenter, FDA-IDE study with 2 arms: decompression with PTB or TLIF. Perioperative and patient-reported clinical outcomes were recorded at baseline, and postoperatively at 6 weeks, 3 months, and 6 months. All patients who reached a minimum of 6-months follow-up were included in this interim analysis. Summary statistics are reported, as well as paired t-tests to assess within-group changes in pain and disability scores. Results: One hundred patients (63 PTB, 37 TLIF) reached 6-months follow-up. Characteristics of PTB and TLIF groups, respectively, were: age 64.5±8.2, 63.9±7.4 yrs; BMI 28.4±4.9, 29.3±5.7; current smokers 2%, 3%. Perioperative outcomes were: operative time 113±29 (PTB) and 174±57 (TLIF) minutes; EBL 44±29 (PTB) and 258±167 (TLIF) mL; LOS 0.6±1.5 (PTB) and 3.4±1.7 (TLIF) days. A statistically significant reduction from baseline to 6 months for mean VAS leg (80.5±9.7 to 19.9±23.0), VAS back (65.6±23.5 to 15.8±21.6), and ODI scores (53.1±12.4 to 13.2±14.1) was reported for PTB patients (all p<0.01); with 87% of patients achieving 20 point ODI improvement. Similar improvements were reported for TLIF patients for VAS leg (78.7±15.7 to 27.9±33.4), VAS back (71.7±18.4 to 22.9±26.8), and ODI (51.2±12.8 to 19.7±21.2) (all p<0.01); with 70% achieving 20 point ODI improvement. During the 6-month follow-up period, 1 PTB subject (1.6%) was revised to posterolateral fusion during the initial hospital stay due to intraoperative spinous process fracture resulting in inability to place the PTB, and 2 (5.4%) TLIF subjects were revised to L3-S1 fusions due to symptom progression, including 1 instance of cage/screw migration. Conclusions: These preliminary results suggest PTB stabilization after decompression for DS with LSS can be accomplished safely without a significant increase in perioperative complications. Short-term improvements in patient-reported outcomes for LimiFlex treated patients are comparable to fusion treated patients. Further investigation will include quantitative comparison between propensity score-matched groups with long-term follow-up. Disclosures: H. Bae: A; Pfizer, Rebosis, Empirical Spine, Medtronic, Simplify Medical, Mesoblast. B; Stryker K2M, DePuy Synthes, Prosidyan, NuVasive. D; Prosidyan, DiFusion, Stryker, NuVasive, Medtronic. F; Stryker K2M, NuVasive, DePuy Synthes, Zimmer Biomet, Prosidyan. I. Cheng: A; Empirical Spine. B; NuVasive, SpineCraft. D; NuVasive, Cytonics, SpinalCyte, Spine Surgical Innovations. F; NuVasive, Globus Medical, Spine Wave. R. Sasso: B; NuVasive. F; Medtronic. A. Villavicencio: A; Empirical Spine. W. Lavelle: A; Empirical Spine, DePuy Synthes, Medtronic, Stryker K2M, Spinal Kinectics, Vertebral Technologies. D; 4WEB, Prosidyan, Cardan Robotics. T. Yoon: A; Empirical Spine, NuVasive, Medtronic, Zimmer Biomet, AOSpine. D; Phygen Spine, Alphatec Spine, Meditech Spine. F; Meditech Spine, Stryker. R. Bains: A; Empirical Spine. K. Calvin: A; Empirical Spine. K. Kee: A; Empirical Spine, Medtronic, Vertex, Mesoblast, InViVo, Therapeudics, FzioMed, Seikagaku. B; MiRus, Globus Medical, Zimmer Biomet. D; Molecular Matrix. F; Zimmer Biomet, Precision Spine. H. Sandhu: A; Empirical Spine. B; BioRestorative Therapies, Prosidyan. D; Spine Wave, Paradigm Spine, Providence Medical Technology. M. Stauff: A; Empirical Spine. B; Intrinsic Spine. K. Sethi: None. J. Fischgrund: None. W. Welch: A; Empirical Spine. R. Davis: None. E. Yu: A; Empirical Spine. C; Johnson & Johnson, AOSpine. H. Deutsch: A; Empirical Spine. B; Titan Spine. S. Berven: A; NIH, NSF, AOSpine, Empirical Spine. B; Medtronic, Stryker, Globus Medical, Innovasis, Medicrea. D; Green Sun Medical, Providence Medical Technology. F; Medtronic, Stryker K2M. M. Mermer: A; Empirical Spine. U. Metkar: A; Empirical Spine. A. Hawasli: A; NREF, CSRS. B; Johnson & Johnson, Cerapedics. D. Crandall: A; Empirical Spine. T. Alamin: A; Empirical Spine. B; Empirical Spine. R. Tallarico: A; Empirical Spine, Medtronic, Stryker K2M, Spinal Kinectics, Vertebral Technologies. B; Stryker K2M. R. Guyer: A; Empirical Spine. CONCURRENT SESSION 2A: EMERGING & NAVIGATION FREE PAPERS Abstracts AnnualForum’19 9ANNUAL FORUM ’19 | LAS VEGAS, NEVADA | OCT. 31–NOV. 2, 2019 Paper #2: Simultaneous Lateral Interbody Fusion with Robot Assisted Pedicle Screw Fixation in Single Position: Seven Consecutive Cases from a Large Volume Center Komal Naeem, MD; Malika Bhargava, MD; Randall Porter, MD; and | Corey Walker, MD Introduction: Robotic arm used in spine surgeries aids in accurate trajectory planning of pedicle screws. Minimally invasive approaches for lateral interbody fusion require lateral decubitus positioning of the patient. A change in position from lateral decubitus to prone is required for the same-day pedicle screw fixation, which adds to the surgical time and decreases the efficiency of this procedure. Aims/Objectives: We present a case-series of single position (lateral decubitus) surgery for lateral interbody fusion and pedicle screw fixation. Methods: We performed a retrospective analysis of all patients who underwent single position surgery for lateral (trans-psoas and pre-psoas) interbody fusion and pedicle screw fixation, treated by senior author. We also collected intraoperative details, prospectively. Gertzbein-Robbins classification was used for pedicle screw accuracy assessment. Grades A and B were considered clinically acceptable. Results: We enrolled seven patients in total, six had single level fusion and one had two-level fusion. Average age was found to be years 68years (SD 9.06years) and mean body mass index of 31.6kg/m2 (SD 5.1kg/m2) was reported. Five (71.4%) patients had spinal instability whereas 4 (57.1%) had scoliosis and one patient had prior lumbar surgery. We do not report any immediate postoperative complications. Hip flexor weakness was reported in 3 patients and was found to be transient in 2, resolved in ~30 days. We do not report hip dysesthesia, hip numbness, new-onset radiculopathy or hardware failure in average follow-up of 6months. Average radiation dose was found to be 238.9mGy (SD130.6mGy) In total, 28 screws were placed, and 2 (9.1%) required repositioning because of medial and lateral breech. Screw accuracy assessment was done for 21 screws and placement of 16 (76.2%) pedicle screws were clinically acceptable (grades A and B). We recorded time for the different steps of surgery for four patients. The average time per screw was reported as 9.8minutes (SD 7.4 minutes). The average time for the entire procedure from skin incision to skin closure was 257minutes (SD27.7minutes). Acquiring intraoperative CT, importing images and screw planning consumed 35% (168 minutes) of total surgical duration. We report good neurological outcomes for all patients. Conclusions: We present the cases for simultaneous minimally invasive approach for lateral interbody fusion and percutaneous pedicle screw fixation in single position. This surgical technique does not only decrease the radiation exposure and blood loss but also reduces the surgical time. We report that this technique can produce favorable outcomes among elderly patients with multiple co-morbids. Disclosures: K. Naeem: None. M. Bhargava: None. R. Porter: A; Barrow Neurological Foundation. B; Globus Medicle, Medtronic, Stryker. D; The medical memory. Paper #3: Improved Bone-Removal Using a New Device in Open and Minimal Invasive Approaches: A 2-Center Experience with 143 Patients John Peloza, MD 1 ; Larry Khoo, MD 2 ; Michael Millgram, MD 3 ; ScottKutz, MD 4 ; Richard Guyer, MD 5 ; and Ely Ashkenazi, MD 3 Center for Spine Care, Dallas, TX 1 ; The Spine Clinic of Los Angeles, Los Angeles, CA 2 ; Assuta Medical Center, Tel Aviv, Israel 3 ; Minimally Invasive Neurosurgery of Texas, Plano, TX 4 ; and Texas Back Institute, Plano, TX 5 Introduction: Spinal procedures often require the removal of bony tissues to prevent nerve compression and reduce pain. Sufficient bone removal is complicated by the need to minimize supporting bony structure destruction. Efficient osteophyte removal can prevent future pain and discomfort and may therefore be necessary in some cases. Traditional bone removal tools and methods limit the surgeon’s ability to reach difficult to access regions and therefore increase healthy bone removal and procedure time. Aims/Objectives: Here we describe and evaluate the experience accumulated using a recently developed, FDA- approved, shielded curved drill, designed to provide efficient bone removal from difficult to access bony structures such as the foramen, while improving procedure safety and speed. Methods: The device was used in 2 centers to perform foraminotomy, osteophyte removal, and disc-space preparation since October 2016. All the procedures for which a record of device use was available were included in the analysis. Overall, 143 procedures were reviewed, including lumbar and cervical spinal fusions and decompressions. Of these 143 procedures, 77 were performed minimally-invasively. Procedure length of time was recorded, as well as the duration of device use. Surgeon assessment was obtained using questionnaires at the end of each procedure. CONCURRENT SESSION 2A: EMERGING & NAVIGATION FREE PAPERS Next >