Acta Neurochirurgica

, Volume 158, Issue 6, pp 1125–1128 | Cite as

Minimally invasive transforaminal lumbar interbody fusion with the ROSATM Spine robot and intraoperative flat-panel CT guidance

  • Louis CheninEmail author
  • Johann Peltier
  • Michel Lefranc
How I Do it - Neurosurgical Techniques



Circumferential arthrodesis is commonly used to treat degenerative lumbar diseases. Minimally invasive techniques may enable faster recovery and reduce the incidence of postoperative infections.


We report on the surgical technique of a transforaminal lumbar interbody fusion (TLIF) procedure performed with the assistance of a new robotic device (ROSATM Spine) and intraoperative flat-panel CT guidance.


The combined use of this new robotic device and intraoperative CT enables accurate and safe arthrodesis in the treatment of degenerative lumbar disc diseases.


Transforaminal Fusion Minimally invasive Robot Intraoperative CT 


Compliance with ethical standards

Conflict of interest

Lefranc has provided consultancy services to Medtech®. The other authors (Chenin, Peltier) report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Supplementary material


Minimally invasive transforaminal lumbar interbody fusion with the ROSATM Spine robot and intraoperative flat-panel CT guidance

The patient is placed in the prone position. The O-arm flat-panel CT device and the ROSA SPINE robot are placed. The specific robot’s fiducial marker enables the robot to monitor its own movements. A percutaneous reference pin is placed in the right iliac wing. This fiducial allowed the robot to track every patient’s movement. Trajectories are planned in the same way as in the brain system, with specification of the screw’s entry point, direction, and final position. Size of each screw is also determined. Then, the robot is positioning exactly on the planned trajectory, with real time navigation guidance. A guide tube needle is placed through the skin and then through the pedicle into the posterior part of the vertebral body. After a guide wire has been placed through the guide-tube needle, the latter is removed. A hole is drilled through the pedicle using real-time, robotized navigation guidance. Guide wire, guide-tube needle and tap are monitored by the robot. all pedicles are threaded and screws are inserted. The two left percutaneous incisions are combined in order to position the mini invasive retractor. In this case of L4-L5 TLIF, exposure of the left L4-L5 articular facet enables initiation of L4-L5 foraminotomy. The surgeon is free to use a navigated pointer to recognize anatomic features more easily. Adequate discectomy then enables placement of the TLIF cage. Arthrodesis is completed by introducing and clamping the rods. The Sextant® percutaneous ancillary system is used for this procedure. Another 3D acquisition is then performed with the O-arm®, in order to check the mounting’s final position. (MP4 190601 kb)


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Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  1. 1.Neurosurgery UnitAmiens University Medical CenterAmiens cedex 1France

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