Abstract
Background
Lateral lumbar interbody fusion supplemented with insertion of pedicle screws is a surgical procedure that has gained popularity in the last years, becoming an important tool in the armamentarium of spine surgeons. In recent years, there is a trend to complete both procedures in a single position, thus avoiding flipping the patient prone to insert the pedicle screws.
Methods
We describe a step-by-step workflow of the robotic-assisted technique for multilevel lateral lumbar interbody fusion supplemented with posterior instrumentation. The surgical procedure is performed in a single lateral position. For access to L4–5 or L5–S1, an oblique abdominal incision is performed in the same position, and the desired disc space is approached through an oblique or anterior corridor in the retroperitoneal space.
Conclusion
Robotic-assisted single-position lateral for multilevel circumferential lumbar interbody fusion is a safe and effective procedure in patients where lumbar stabilization is required. This technique provides patients with a faster recovery and low risk of complications.
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Data availability
Data and materials presented in the current study are available from the corresponding author on reasonable request.
Code availability
Not applicable.
References
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Authors and Affiliations
Contributions
LAR: methodology, original draft, conceptualization, and writing. SS: methodology, writing, visualization, and review. TU: methodology, supervision, writing—review and editing.
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Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Miami and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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The patients consented to the publication of their case in this paper.
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The authors declare no competing interests.
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Key Points
1. Robotic-assisted single lateral position is an adequate option for multilevel circumferential lumbar interbody, especially when a shorter operative time is desired.
2. The anatomy of vascular structures and psoas muscle should be carefully studied before surgery. The presence of vascular structures hindering the access to the disc, or an anterior position of psoas muscle may indicate that a different approach is more suitable.
3. In cases of L4-5 disc surgery, the position of the iliac crest is analyzed to determine the suitability of a lateral approach at that level.
4. In cases of scoliosis, it is important to study the characteristics of the curve to plan the lateral approach and orientation of the pedicle screws insertion.
5. Because more personnel and equipment are necessary to perform both surgeries, the operating room setup must be adequately organized to allow surgeons to work comfortably.
6. Patient is firmly immobilized and fixed to the table to prevent any movement during surgery. A gel roll is inserted in the waist to open the space between the rib cage and pelvis.
7. After prepping and draping the patient, the navigation frame is inserted in the iliac crest, then the O arm and the robotic system are used to establish the surgical plan. Pedicle screw size and trajectory should be selected in the robot before starting surgery.
8. Performing both surgical procedures simultaneously results in a shorter operative time and fewer complications.
9. If an interbody lumbar fusion at L5-S1 is required, it can be performed during the same lateral position by using a different anterolateral abdominal incision.
10. RASLPC is a low-risk and effective technique to perform circumferential stabilization. Single position lateral shows the same clinical outcome and local lordosis compared to two-stage surgery.
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Robles, L.A., Shah, S. & Urakov, T. Robotic-assisted single-position lateral for multilevel circumferential lumbar interbody fusion: how I do it. Acta Neurochir 165, 3963–3967 (2023). https://doi.org/10.1007/s00701-023-05874-2
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DOI: https://doi.org/10.1007/s00701-023-05874-2