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Robot-assisted multi-level anterior lumbar interbody fusion: an anatomical study

  • Original Article - Spine - Other
  • Published:
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Abstract

Background

Minimally invasive surgical approaches still provide limited exposure. Access to the L2–L5 intervertebral discs during a single procedure is challenging and often requires repositioning of the patient and adopting an alternative approach.

Objectives

Investigate the windows to the L2–L5 intervertebral discs to assess the dimensions of the interbody implants suitable for the procedure and evaluate the feasibility of multi-level lumbar intervertebral disc surgery in robot-assisted surgery (RAS)

Methods

Sixteen fresh-frozen cadaveric specimens underwent a retroperitoneal approach to access the L2–L5 intervertebral discs. The L2–L3 to L4–L5 windows were defined as the distance between the left lateral border of the aorta (or nearest common iliac vessel) and the medial border of the psoas, measured in a static state and after gentle medial retraction of the vascular structures. Two living porcine specimens and one cadaveric specimen underwent da Vinci robot-assisted transperitoneal approach to expose the L2–L3 to L4–L5 intervertebral discs and perform multi-level discectomy and interbody implant placement.

Results

The L2–L3 to L4–L5 intervertebral disc windows significantly increased from a static to a retracted state (p < 0.05). The mean L2–L3, L3–L4, and L4–L5 windows measured respectively 20.1, 21.6, and 19.6 mm in the static state, and 27.2, 30.9, and 30.3 mm after gentle vascular retraction. The intervertebral windows from L2–L3 to L4–L5 were successfully exposed through an anterior transperitoneal approach with the da Vinci robot on the cadaveric and living porcine specimens, and interbody implants were inserted.

Conclusion

RAS appears to be feasible for a mini-invasive multi-level lumbar intervertebral disc surgery. The RAS procedure, longer and more expensive than conventional MIS approaches, should be reserved for elective patients.

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Abbreviations

ALIF:

Anterior lumbar interbody fusion

BMI:

Body mass index

MIS:

Minimally invasive surgical

OLIF:

Oblique lumbar interbody fusion

RAS:

Robot-assisted surgery

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Author information

Authors and Affiliations

  1. Department of Spine Surgery, Timone University Hospital, Marseille, France

    Lucas Troude, Benjamin Blondel & Stéphane Fuentes

  2. Department of Neurosurgery, Timone University Hospital, 264 Rue Saint-Pierre, 13385, Marseille, France

    Sébastien Boissonneau & Henry Dufour

  3. Vascular Surgery, CHU Nancy, Nancy, France

    Segueï Malikov

  4. Department of Anatomy, Faculty of Medicine, Aix-Marseille University, 264 Rue Saint-Pierre, 13385, Marseille, France

    Pierre Champsaur

Authors
  1. Lucas Troude
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  2. Sébastien Boissonneau
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  3. Segueï Malikov
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  4. Pierre Champsaur
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  5. Benjamin Blondel
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  6. Henry Dufour
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  7. Stéphane Fuentes
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Corresponding author

Correspondence to Sébastien Boissonneau.

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This article does not contain any studies with human participants performed by any of the authors. The Institutional Animal Care and Use Committee approved the experimental protocol.

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The authors declare that they have no conflict of interest.

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This article is part of the Topical Collection on Spine - Other

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Troude, L., Boissonneau, S., Malikov, S. et al. Robot-assisted multi-level anterior lumbar interbody fusion: an anatomical study. Acta Neurochir 160, 1891–1898 (2018). https://doi.org/10.1007/s00701-018-3621-x

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  • DOI: https://doi.org/10.1007/s00701-018-3621-x

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