Minimally Invasive Robotic Lumbar Facet Decortication

Abstract

Minimally invasive percutaneous pedicle screws (PPS) are placed through muscle sparing paramedian incisions and provide rigid 3 column fixation to promote stability and fusion. Percutaneous pedicle instrumentation is generally performed as adjunctive posterior stabilization after anterior lumbar interbody fusion or lateral lumbar interbody fusion procedures. In these instances, arthrodesis is often achieved through the interbody fusion rather than posterior column fusion. In some cases, the surgeon may choose to perform posterior facet fusion in addition to PPS and anterior interbody. The addition of a minimally invasive facet fusion to PPS and anterior column interbody fusion creates more fusion surface and enables a truly circumferential fusion. While robotic-guided facet decortication has been suggested, there are currently no published techniques. Here, we describe a novel minimally invasive technique to perform percutaneous robotic facet decortication in conjunction with PPS following anterior lumbar interbody fusion or lateral lumbar interbody fusion.

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

“…Utilizing a preoperative plan similar to that used in percLIF, the robotic arm swings into position. Rather than placing a pedicle screw or tap, a large burr is inserted through the guide to facilitate facet decortication ( 40 , 41 ). Yet another advancement was shown in the cases of iliac fixation, where we were able to successfully perform iliolumbar fixation percutaneously without the need for a side connector, which is a potential place of weakness and failure ( 42 ).…”