Awake percutaneous transforaminal lumbar interbody fusion with expandable cage and robotic-assisted navigation and instrumentation: Case report and review of literature

Wang, Timothy Y.; Mehta, Vikram A.; Sankey, Eric W.; Than, Khoi D.; Goodwin, C. Rory; Karikari, Isaac O.; Gupta, Dhanesh K.; Abd-El-Barr, Muhammad M.

doi:10.1016/j.inat.2020.100685

Cited by 7 publications

(10 citation statements)

References 21 publications

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“…As our group has previously reported, patient 1 had a history of adverse reaction to general anesthesia. 7 Because he was hesitant to undergo general anesthesia, our team proceeded with a neuraxial spinal block at the level of L3 to L4. 7 Surgery proceeded without complication.…”

Section: Resultsmentioning

confidence: 99%

Robotic-Assisted Trajectory Into Kambin's Triangle During Percutaneous Transforaminal Lumbar Interbody Fusion—Initial Case Series Investigating Safety and Efficacy

Dalton¹,

Sykes²,

Wang³

et al. 2021

Operative Surg.

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BACKGROUND Minimally invasive spine surgery (MISS) has the potential to further advance with the use of robot-assisted (RA) techniques. While RA pedicle screw placement has been extensively investigated, there is a lack of literature on the use of the robot for other tasks, such as accessing Kambin's triangle in percutaneous lumbar interbody fusion (percLIF). OBJECTIVE To characterize the surgical feasibility and preliminary outcomes of an initial case series of 10 patients receiving percLIF with RA cage placement via Kambin's triangle. METHODS We performed a single-center, retrospective review of patients undergoing RA percLIF using robot-guided trajectory to access Kambin's triangle for cage placement. Patients undergoing RA percLIF were eligible for enrollment. Baseline health and demographic information in addition to peri- and postoperative data was collected. The dimensions of each patient's Kambin's triangle were measured. RESULTS Ten patients and 11 levels with spondylolisthesis were retrospectively reviewed. All patients successfully underwent the planned procedure without perioperative complications. Four patients underwent their procedure with awake anesthesia. The average dimension of Kambin's triangle was 66.3 m2. With the exception of 1 patient who stayed in the hospital for 7 d, the average length of stay was 1.2 d, with 2 patients discharged the day of surgery. No patients suffered postoperative motor or sensory deficits. Spinopelvic parameters and anterior and posterior disc heights were improved with surgery. CONCLUSION As MISS continues to evolve, further exploration of robot-guided surgical practice, such as our technique, will lead to creative solutions to challenging anatomical variation and overall improved patient care.

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Section: Resultsmentioning

confidence: 99%

Robotic-Assisted Trajectory Into Kambin's Triangle During Percutaneous Transforaminal Lumbar Interbody Fusion—Initial Case Series Investigating Safety and Efficacy

Dalton¹,

Sykes²,

Wang³

et al. 2021

Operative Surg.

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“…Use of the RA method has allowed for iliac fixation in destructive sacral lesions, sacroiliac fusions, and percLIF through Kambin’s Triangle. In addition to improving safety and accuracy, RA technology has allowed for faster recovery, same day discharges, minimal blood loss obviating transfusions, decreased radiation exposure, and shorter lengths of stay ( 16 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience

et al. 2022

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Interest in robotic-assisted spine surgery has grown as surgeon comfort and technology has evolved to maximize benefits of time saving and precision. However, the Food and Drug Administration (FDA) has currently only approved robotics to assist in determining the ideal trajectory for pedicle screw placement after extensive research supporting its efficacy and efficiency. To be considered a durable and effective option, robotics need to expand beyond the indication of just placing pedicle screws. This article aims to illustrate a multi-surgeon, single-institution experience with unique applications of robotic technologies in spine surgery. We will explore accessing Kambin’s Triangle in percutaneous transforaminal interbody fusion (percLIF), iliac fixation in metastatic cancer, and sacroiliac (SI) fusions. Each of these topics will be covered in depth with associated background information and subsequent discussion. We show that with proper understanding of its limitations, robots can help surgeons perform difficult surgeries in a safe manner.

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“…A case series investigating robotic-assisted trajectory into Kambin triangle during percLIF demonstrates the safety and precision granted by the robot in accessing lumbar disc spaces without the need for laminectomies or facetectomies, and without sustaining postoperative motor or sensory deficits. 83 Wang et al 84 further discuss the utilization of the trans-Kambin technique with robotic guidance in conjunction with preoperative MRI and CT images to successfully plan a percutaneous lateral trajectory in an awake patient under spinal anesthesia.…”

Section: Emerging Applications Minimally Invasive Techniquesmentioning

confidence: 99%

Robotic Spine Surgery: Past, Present and Future.

Perfetti

Kisinde

Rogers-LaVanne

et al. 2022

Spine

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Study Design. Systematic review. Objective. The aim of this review is to present an overview of robotic spine surgery (RSS) including its history, applications, limitations, and future directions. Summary of Background Data. The first RSS platform received United States Food and Drug Administration approval in 2004. Since then, robotic-assisted placement of thoracolumbar pedicle screws has been extensively studied. More recently, expanded applications of RSS have been introduced and evaluated. Methods. A systematic search of the Cochrane, OVID-MEDLINE, and PubMed databases was performed for articles relevant to robotic spine surgery. Institutional review board approval was not needed. Results. The placement of thoracolumbar pedicle screws using RSS is safe and accurate and results in reduced radiation exposure for the surgeon and surgical team. Barriers to utilization exist including learning curve and large capital costs. Additional applications involving minimally invasive techniques, cervical pedicle screws, and deformity correction have emerged. Conclusion. Interest in RSS continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques. IRB Approval. N/A.

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Awake percutaneous transforaminal lumbar interbody fusion with expandable cage and robotic-assisted navigation and instrumentation: Case report and review of literature

Cited by 7 publications

References 21 publications

Robotic-Assisted Trajectory Into Kambin's Triangle During Percutaneous Transforaminal Lumbar Interbody Fusion—Initial Case Series Investigating Safety and Efficacy

Robotic-Assisted Trajectory Into Kambin's Triangle During Percutaneous Transforaminal Lumbar Interbody Fusion—Initial Case Series Investigating Safety and Efficacy

Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience

Robotic Spine Surgery: Past, Present and Future.

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