Female Sex and Supine Proximal Lumbar Lordosis are Associated with the Size of the LLIF “Safe Zone” at L4-5

Fourman, Mitchell S.; Alluri, Ram K.; Sarmiento, J. Manuel; Lyons, Keith; Lovecchio, Francis; Araghi, Kasra; Dalal, Sidhant; Shinn, Dan; Song, Junho; Shahi, Pratyush; Melissaridou, Dimitra; Carrino, John A.; Sheha, Evan; Iyer, Sravisht; Dowdell, James; Qureshi, Sheeraz A.

doi:10.1097/brs.0000000000004541

Cited by 2 publications

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“…(14) TLIF or LLIF was performed as described previously in the literature. [14][15][16][17][18][19][20] Robotic navigation was utilized for disc preparation and interbody placement. (15) Passage of rods under lateral fluoroscopy.…”

Section: Study Design and Populationmentioning

confidence: 99%

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Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws

et al. 2023

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Objective: To analyze the usage of floor-mounted robot in minimally invasive lumbar fusion.Methods: Patients who underwent minimally invasive lumbar fusion for degenerative pathology using floor-mounted robot (ExcelsiusGPS) were included. Pedicle screw accuracy, proximal level violation rate, pedicle screw size, screw-related complications, and robot abandonment rate were analyzed.Results: Two hundred twenty-nine patients were included. Most surgeries were primary single-level fusion. Sixty-five percent of surgeries had intraoperative computed tomography (CT) workflow, 35% had preoperative CT workflow. Sixty-six percent were transforaminal lumbar interbody fusion, 16% were lateral, 8% were anterior, and 10% were a combined approach. A total of 1,050 screws were placed with robotic assistance (85% in prone position, 15% in lateral position). Postoperative CT scan was available for 80 patients (419 screws). Overall pedicle screw accuracy rate was 96.4% (prone, 96.7%; lateral, 94.2%; primary, 96.7%; revision, 95.3%). Overall poor screw placement rate was 2.8% (prone, 2.7%; lateral, 3.8%; primary, 2.7%; revision, 3.5%). Overall proximal facet and endplate violation rates were 0.4% and 0.9%. Average diameter and length of pedicle screws were 7.1 mm and 47.7 mm. Screw revision had to be done for 1 screw (0.1%). Use of the robot had to be aborted in 2 cases (0.8%).Conclusion: Usage of floor-mounted robotics for the placement of lumbar pedicle screws leads to excellent accuracy, large screw size, and negligible screw-related complications. It does so for screw placement in prone/lateral position and primary/revision surgery alike with negligible robot abandonment rates.

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Section: Study Design and Populationmentioning

confidence: 99%

“…(16) X-rays to confirm good positioning of all hardware. (17) For ALIF, the robot was used only for bilateral percutaneous pedicle screw placement in the prone position after anterior interbody placement was done with the patient supine.…”

Section: Study Design and Populationmentioning

confidence: 99%

Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws

et al. 2023

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Elimination of Lumbar Plexus Injury by Changing the Entry Point and Traction Direction of the Psoas Major Muscle in Transpsoas Lateral Lumbar Spine Surgery

et al. 2023

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Background and Objectives: The lateral approach is commonly used for anterior column reconstruction, indirect decompression, and fusion in patients with lumbar degenerative diseases and spinal deformities. However, intraoperative lumbar plexus injury may occur. This is a retrospective comparative study to investigate and compare neurological complications between the conventional lateral approach and a modified lateral approach at L4/5. Materials and Methods: Patients with a lumbar degenerative disease requiring single-level intervertebral fusion at L4/5 were included and categorized into group X and group A. Patients in group X underwent conventional extreme lateral interbody fusion, while those in group A underwent a modified surgical procedure that included splitting of the anterior third of the psoas muscle, which was dilated by the retractor on the anterior third of the intervertebral disc. The incidence of lumbar plexus injury, defined as a decrease of ≥1 grade on manual muscle testing of hip flexors and knee extensors and sensory impairment of the thigh for ≥3 weeks, on the approach side, was investigated. Results: Each group comprised 50 patients. No significant between-group differences in age, sex, body mass index, and approach side were observed. There was a significant between-group difference in intraoperative neuromonitoring stimulation value (13.1 ± 5.4 mA in group X vs. 18.5 ± 2.3 mA in group A, p < 0.001). The incidence of neurological complications was significantly higher in group X than in group A (10.0% vs. 0.0%, respectively, p < 0.05). Conclusions: In our modified procedure, the anterior third of the psoas muscle was entered and split, and the intervertebral disc could be reached without damaging the lumbar plexus. When performing lumbar surgery using the lateral approach, lumbar plexus injury can be avoided by following surgical indication criteria based on the location of the lumbar plexus with respect to the psoas muscle and changing the transpsoas approach to the intervertebral disc.

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Female Sex and Supine Proximal Lumbar Lordosis are Associated with the Size of the LLIF “Safe Zone” at L4-5

Cited by 2 publications

References 22 publications

Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws

Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws

Elimination of Lumbar Plexus Injury by Changing the Entry Point and Traction Direction of the Psoas Major Muscle in Transpsoas Lateral Lumbar Spine Surgery

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