Article
Robotic assisted, minimally invasive single position prone lateral interbody fusion (MI-LLIF) – a single centre experience
Robotisch assistierte, minimal invasive laterale single position lumbale interkorporelle Fusion (MI-LLIF)-monozentrische Erfahrung
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Published: | May 25, 2022 |
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Objective: Opposite to the common transpsoas approach in the lateral decubitus position followed by dorsal screw fixation we adopted a minimally invasive robotic assisted single prone position approach for the treatment of adult degenerative and inflammatory diseases of the spine. We want to share our early experience utilizing this technique.
Methods: All cases operated with this technique between April and October 2021 were prospectively evaluated. A planning computed tomography (CT) was performed one day prior the operation, followed by screw and cage planning and transfer of the data to the robot. Intraoperative matching was accomplished by 2-D fluoroscopy. Screw placement, followed by lateral cage placement was performed by a single surgeon utilizing robotic navigation. Beside demographic data, underlying pathology, intra- and postoperative complications, abortion of robotic navigation, postoperative x-ray, the duration of hospitalization after operation, as well as single level transpsoas retractor time were evaluated.
Results: 21 adult Patients (14 females and 7 males) were treated using this technique. The indication for surgery was predominantly degenerative adult deformity (19 Patients) and Spondylodiscitis (2 patients). The mean age of the patients was 64.1 (range 32-82) years. A total of 38 levels were operated, most frequently L3/4 (n = 14) followed by L2/3 (n = 12), L4/5 (n = 11) and L1/2 (n = 1), respectively. There were no intraoperative complications. None of the robotic assisted procedures had to be aborted. Access related complications were observed in 2 Patients (9.5 %) who suffered from transient post-operative lumbar plexus palsy with motor weakness which completely resolved until 3 months follow up. Only one patient had to be revised (4.7 %) because the cage was placed too lateral. The mean duration of hospitalization after the operation was 6.3 (range 4-12) days. Mean retractor time was 13.7 (range 8.4-19.2) minutes in comparison to a prior case series of the same surgeon without robotic navigation of 18.6 (range 12.2-21.4) minutes.
Conclusion: Our early results and experience of the robotic assisted (MI-LLIF) technique is promising. It is a safe and practical alternative to the staged procedure. The reduction of the retractor time, as well as the usage of the familiar prone position seem to be a real advantage.