Single Position Lateral Lumbar Interbody Fusion With Posterior Instrumentation Utilizing Computer Navigation and Robotic Assistance: Retrospective case review and surgical technique considerations

Abstract

Study Design Retrospective cohort study. Objective To determine safety and short-term outcomes of single-position lateral lumbar interbody fusion (LLIF) with bilateral posterior instrumentation and robotic assistance. The article also describes surgical technique considerations for the procedure. Methods 20 patients underwent single-position LLIF with posterior instrumentation and robotic assistance. The patients were followed for a minimum of 3 months post-operatively. Results Average operative time was 211 ± 34 minutes, average blood loss was 51.25 ± 17 cc’s, and average length of stay was 1.4 ± .75 days. There were no intraoperative complications, readmissions, revision surgeries, and no incidence of hardware malposition. Significant improvement in pain and ODI scores was noted at 3 month follow up. Conclusions The study demonstrated safety and short-term clinical efficacy of minimally invasive single-position lateral lumbar interbody fusion with bilateral posterior instrumentation utilizing robotic assistance and navigation. There are certain surgical technique considerations that must be followed to ensure optimal surgical workflow and predictable outcomes.

A retrospective review of single-position prone lateral lumbar interbody fusion cases: early learning curve and perioperative outcomes

“…In most operating rooms, the flip from lateral decubitus to prone can add significant operative time to the surgery resulting in extended anaesthesia usage and increased hospital costs. Several workarounds have been created to improve efficiency in the lateral position, including standalone interbodies, lateral plate fixation, and unilateral pedicle screws [6,7]. Although possible, these workarounds have not come into general favour with the larger spine community.…”

The one-stop-shop approach: Navigating lumbar 360-degree instrumentation in a single position

“…Regarding the application of robot-assisted navigated pedicle screw placement for 360-degree surgeries in a single positioning, Sinkov et al reported limitations regarding contralateral pedicle screw placement due to problems accessing the surgical site in lateral decubitus positioning ( 34 ).…”

“…Sellin et al applied CT-guided navigation for simultaneous lateral interbody fusion and pedicle screw placement in lateral positioning showing reduced radiation exposure and reduced duration of surgery, especially as intraoperative navigation replaced intraoperative fluoroscopy and therefore allowed the parallel execution of both procedures (32). Ikuma et al compared singlepositioning surgery in a right lateral decubitus positioning for cases with and without spinal navigation, showing a significantly reduced duration of surgery for cases with spinal navigation as spinal navigation partially enabled simultaneous anterior and posterior instrumentation (33).…”

The Evolution of Lateral Lumbar Interbody Fusion: A Journey from Past to Present

“…For screw application, the robotic arm moves along the preplanned trajectory with precision, enabling the use of instrumentation through the arm. Navigated instruments are then introduced through the robotic arm into the pedicle, preparing it for screw application, with the robotic arm maintaining a fixed trajectory [ 163 ]. These robots are being utilized both during L-SPS and P-SPS ( Figure 5 ) [ 164 ].…”