gms | German Medical Science

Objective: Feasibility of robotic-assisted minimally invasive guided oblique lumbar interbody fixation (GO-LIF) in degenerative spondylolisthesis of the lumbar spine.

Method: 26 pts. (mean age 67±8 yrs.; 18 f., 8 m.) were operated using the GO-LIF technique (“Guided Oblique Lumbar Interbody Fixation”). This technique fix transdiscally single level by bilateral screw insertion between lower pedicles and the cranial vertebral body. A single cage was added using a midline incision, in 17 cases. Patients with advanced osteochondrosis and low disc space were fixated by screws and posterolateral fusion (n=9). They suffered from spondylolisthesis grade I-II (level L 3/4–L 5/S1) and were treated minimally invasive and robotic–assisted (“Spine Assist”). Clinical (VAS, ODI, SSSS) and radiological follow-up (x-ray) continued over 12 months.

Results: 36/49 screws were positioned according to the preoperative planning. In 13/49 screws the navigated trajectory had to be corrected according to intraoperative flouroscopic images. 90,2% of screws were placed in the pedicle, 7,3 % breaching less than 2 mm and 2,4% over 2 mm. Axial deviation of screw trajectories was 0.27 mm ± 2.03 mm and angle deviation 1.94° ± 2.43°. Positioning of cages was uneventful (n=17). The procedure had to be changed unilaterally to a transpedicular fixation in 2 pts. One screw was misplaced and intraoperatively removed. Radiation exposure (mean 3.5 min) was not reduced so far since this technique was recently implemented. VAS, ODI and SSSS demonstrated a postoperative significant clinical improvement.

Conclusions: Robotic-assisted and guided direct pediculo-body fixation is a feasible minimally invasive and good alternative method compared to established fixation techniques in the right indications.