Clinical Effects of Oblique Lateral Interbody Fusion by Conventional Open
            versus
            Percutaneous Robot‐Assisted Minimally Invasive Pedicle Screw Placement in Elderly Patients

Abstract Background: Robot-assisted pedicle screw placement is usually performed under general anaesthesia to keep the body still. The aim of this study was to compare the accuracy of the robot-assisted technique under regional anaesthesia with conventional fluoroscopy-guided percutaneous pedicle screw placement under general anaesthesia in minimally invasive lumbar fusion surgery.Methods: Patients who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) from December 2017 to February 2020 in a single centre were included. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anaesthesia (group RE-RO) and fluoroscopy-guided under general anaesthesia (group GE-FLU) groups. The primary outcome measures were screw accuracy and the incidence of facet joint violation (FJV). Secondary outcome measures included X-ray exposure and intraoperative adverse events.Results: Eighteen patients were included in group RE-RO, and 23 patients were included in group GE-FLU. The percentages of clinically acceptable screws (Gertzbein and Robbins grades A and B) were 94.4% and 91.5%, respectively. There was no significant difference in the percentages of clinically acceptable screws (p=0.44) or overall Gertzbein and Robbins screw accuracy grades (p=0.35). Only the top screws were included in the analysis of FJVs. The percentages of FJV (Babu grades 1, 2 and 3) were 5.6% and 28.3%, respectively. This difference was statistically significant (p=0.01). Overall, the FJV grades in group RE-RO were significantly better than those in group GE-FLU (p=0.009). The mean fluoroscopy time for each screw in group RE-RO was significantly shorter than that in group GE-FLU (group RE-RO, 5.4±1.9 seconds, group GE-FLU, 6.8±2.0 seconds; P=0.03). The intraoperative adverse events included 1 case of registration failure and 1 case of guide-wire dislodgment in group RE-RO as well as 2 cases of screw misplacement in group GE-FLU. No complications related to anaesthesia were observed.Conclusion: Robot-assisted pedicle screw placement under regional anaesthesia can be performed effectively and safely. The accuracy is comparable to the conventional technique. Moreover, this technique has the advantage of fewer FJVs and a lower radiation time.

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Robot-assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique

Orthopaedic Surgery ◽

10.1111/os.12428 ◽

2019 ◽

Vol 11 (1) ◽

pp. 25-33 ◽

Cited By ~ 3

Author(s):

Jing-ye Wu ◽

Qiang Yuan ◽

Ya-jun Liu ◽

Yu-qing Sun ◽

Yong Zhang ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Screw Fixation ◽

Safety Evaluation ◽

Invasive Technique ◽

Robot Assisted ◽

Fusion Procedure ◽

Oblique Lateral Interbody Fusion ◽

Transfacet Screw Fixation ◽

Lateral Interbody

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Navigated robot-guided pedicle screws placed successfully in single-position lateral lumbar interbody fusion

Journal of Robotic Surgery ◽

10.1007/s11701-019-01034-w ◽

2019 ◽

Vol 14 (4) ◽

pp. 643-647 ◽

Cited By ~ 4

Author(s):

Kade T. Huntsman ◽

Jessica R. Riggleman ◽

Leigh A. Ahrendtsen ◽

Charles G. Ledonio

Keyword(s):

Minimally Invasive ◽

Pedicle Screw ◽

Interbody Fusion ◽

Pedicle Screws ◽

Screw Placement ◽

Lead Author ◽

Lumbar Interbody Fusion ◽

Pedicle Screw Placement ◽

Robot Assisted ◽

Lateral Lumbar Interbody Fusion

Abstract Minimally invasive lateral interbody fusion has distinct advantages over traditional posterior approaches. When posterior stabilization is needed, percutaneous placement of pedicle screws from the lateral decubitus position may potentially increase safety and improve operative efficiency by precluding the need for repositioning. However, safe placement of pedicle screws in the lateral position remains technically challenging. This study describes the pedicle screw placement of single-position lateral lumbar interbody fusion (SP-LLIF) cases in which navigated robotic assistance was used. A single-surgeon, single-site, retrospective Institutional Review Board-exempt review of the first 55 SP-LLIF navigated robot-assisted spine surgery cases performed by the lead author was conducted. An orthopaedic surgeon evaluated screw placement using plain film radiographs. In addition, pedicle screw malposition, reposition, and return to operating room (OR) rates were collected. In the first 55 SP-LLIF cases, 342 pedicle screws were placed. The average patient age and body mass index were 67 years and 29.5 kg/m2, respectively. Of the 342 screws placed, 4% (14/342) were placed manually without the robot, due to surgeon discretion. Of the 328 screws placed with the robot, 2% (7/328) were repositioned based on the surgeon’s discretion, resulting in a 98% navigated robot-assisted pedicle screw placement success rate. In this cohort there were no revisions due to malpositioned screws. No complications due to screw placement were reported. This study demonstrates a high level (98%) of successful surgeon-assessed pedicle screw placement in minimally invasive navigated robot-assisted SP-LLIF, with no malpositions requiring a return to the OR.

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Oblique Lateral Interbody Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis

SSRN Electronic Journal ◽

10.2139/ssrn.3878832 ◽

2021 ◽

Author(s):

Fei-Long Wei ◽

Tian Li ◽

Quan-You Gao ◽

Kai-Long Zhu ◽

Ming-Rui Du ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Lateral Interbody Fusion ◽

Lumbar Spinal ◽

Oblique Lateral Interbody Fusion ◽

Lateral Interbody

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Comparison of Outcomes of Oblique Lateral Interbody Fusion with Percutaneous Posterior Fixation in Lateral Position and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis

Asian Spine Journal ◽

10.31616/asj.2019.0342 ◽

2020 ◽

Author(s):

Yoshinao Koike ◽

Yoshihisa Kotani ◽

Hidemasa Terao ◽

Norimasa Iwasaki

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Degenerative Spondylolisthesis ◽

Transforaminal Lumbar Interbody Fusion ◽

Lateral Position ◽

Posterior Fixation ◽

Lumbar Interbody Fusion ◽

Lateral Interbody Fusion ◽

Oblique Lateral Interbody Fusion ◽

Lateral Interbody

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Minimally Invasive Single-Position Lateral Interbody Fusion With Robotic Bilateral Percutaneous Pedicle Screw Fixation: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy240 ◽

2018 ◽

Vol 16 (4) ◽

pp. E121-E121 ◽

Cited By ~ 3

Author(s):

Corey T Walker ◽

Jakub Godzik ◽

David S Xu ◽

Nicholas Theodore ◽

Juan S Uribe ◽

...

Keyword(s):

Minimally Invasive ◽

Pedicle Screw ◽

Interbody Fusion ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Screw Placement ◽

Lateral Interbody Fusion ◽

Percutaneous Pedicle Screw ◽

Percutaneous Pedicle Screw Fixation ◽

Lateral Interbody

Abstract Lateral interbody fusion has distinct advantages over traditional posterior approaches. When adjunctive percutaneous pedicle screw fixation is required, placement from the lateral decubitus position theoretically increases safety and improves operative efficiency by obviating the need for repositioning. However, safe cannulation of the contralateral, down-side pedicles remains technically challenging and often prohibitive. In this video, we present the case of a 59-yr-old man with refractory back pain and bilateral lower extremity radiculopathy that was worse on the left than right side. The patient provided written informed consent before undergoing treatment. We performed minimally invasive single-position lateral interbody fusion with robotic (ExcelsiusGPS, Globus Medical Inc, Audubon, Pennsylvania) bilateral percutaneous pedicle screw fixation for the treatment of asymmetric disc degeneration, dynamic instability, and left paracentral disc herniation with corresponding stenosis at the L3-4 level. A left-sided minimally invasive transpsoas lateral interbody graft was placed with fluoroscopic guidance. Without changing the position of the patient or breaking the sterile field, an intraoperative cone-beam computed tomography image was obtained for navigational screw placement with stereotactic trackers in the iliac spine. Screw trajectories were planned using the robotic navigation software and were placed percutaneously in the bilateral L3 and L4 pedicles using the robotic arm. Concomitant lateral fluoroscopy may be used if desired to ensure the fidelity of the robotic guidance. The patient recovered well postoperatively and was discharged home within 36 h, without complication. Single-position lateral interbody fusion and percutaneous pedicle screw fixation can be accomplished using robotic-assisted navigation and pedicle screw placement. Used with permission from Barrow Neurological Institute.

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