Simultaneous Robotic Single Position Oblique Lumbar Interbody Fusion With Bilateral Sacropelvic Fixation in Lateral Decubitus

Abstract

Single position lateral fusion reduces the need for a secondary surgery and robotic guidance allows for potentially higher accuracy of screw placement. We expand the role of robotics with a simultaneous workflow where 2 surgeons can work in single position surgery and discuss the technical feasibility of placement of S2-alar-iliac (S2AI) screws in the lateral position. A 70-year-old male presented with chronic back pain and bilateral leg pain with the left side worse than the right. He subsequently underwent an L3-S1 oblique lumbar interbody fusion (OLIF) with a minimally invasive L3-ilium robotic posterior spinal fixation simultaneously in single lateral position with S2AI screws. The software planning requisite of robotics allowed for a preoperative plan where lumbar cortical screws were used to line up with bilateral S2AI screws. Intraoperatively, the OLIF was performed anterior to the patient which allowed for a second surgeon to perform the posterior stage of screw placement simultaneously in overlapping fashion during OLIF exposure. Once all screws were placed, the OLIF discectomy and cage placement were completed. As the OLIF incision is closed, rodding proceeds posteriorly with subsequent closure simultaneously as well. Operative time from skin incision to skin closure was 3 hours and 47 minutes. We present here a novel technical report on the recommended workflow of simultaneous robotic single position surgery OLIF and demonstrate the feasibility of placement of sacroiliac fixation in the lateral decubitus position. We believe this technique to be minimally invasive, effective, with the benefit of shortening valuable operating room case time.

Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review

“…Navigated OLIF can also be performed with robotic assistance for posterior pedicle screw instrumentation [ 97 ]. More recently, the application of robotic and navigation-assisted OLIF in a single position has been expanded to the lumbosacral junction: OLIF at L5–S1 and posterior sacropelvic fixation [ 98 , 99 ]. Because this is a still-evolving technique, future studies investigating the long-term outcomes and cost-effectiveness of these technical advancements should follow.…”

Efficacy of Single-Position Oblique Lateral Interbody Fusion Combined With Percutaneous Pedicle Screw Fixation in Treating Degenerative Lumbar Spondylolisthesis: A Cohort Study

“…Recently, Kotani et al ( 40 ) found that single-position OLIF can provide a comparable fusion rate, segmental radiologic alignment, and symptomatic adjacent segment degeneration to MIS-TLIF surgery. Pham et al ( 41 ) presented a novel technical report on the recommended workflow of simultaneous robotic single-position OLIF and demonstrated the'feasibility of placement of sacroiliac fixation in the lateral decubitus position. In addition, Diaz-Aguila et al ( 26 ) found that robot-assisted OLIF can reduce the operative time while ensuring accurate and timely screen placement with minimal complications.…”

Postoperative Urinary Retention After Oblique Lumbar Interbody Fusion Under the Systematic Management Protocol

“…The standard surgical procedures were performed as follows: 9,[12][13][14]17 1. After general anesthesia, the patient was placed in the left lateral decubitus position after an indwelling urinary catheter was inserted.…”