Robot-assisted minimally invasive transforaminal interbody fusion: a complete workflow pilot feasibility study

Area of Science:

• Spine Surgery
• Robotics in Medicine
• Minimally Invasive Procedures

Background:

• Robotic-assisted spinal surgery enhances instrumentation accuracy and reduces recovery time.
• Current robot-assisted spine surgery is limited to pedicle screw placement.
• This study investigates the feasibility of robotic assistance in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), including interbody cage placement.

Purpose of the Study:

• To assess the feasibility of using the Mazor X Stealth robotic-arm platform for MIS-TLIF.
• To evaluate the inclusion of interbody cage placement within the robotic-assisted MIS-TLIF procedure.
• To explore patient demographics and post-operative outcomes in robot-assisted MIS-TLIF (RA-TLIF).

Main Methods:

• A single-center, single-surgeon prospective case series.
• 29 patients underwent planned robot-assisted MIS-TLIF (RA-TLIF) using the Mazor X Stealth system.
• Data collected included patient demographics and post-operative outcomes.

Main Results:

• Two cases were excluded due to software start-up issues.
• One patient required revision surgery for a posterior-migrated interbody cage.
• No loosening of posterior instrumentation was observed at 6-month follow-up.

Conclusions:

• The Mazor X Stealth RA-TLIF demonstrated high pedicle screw insertion accuracy and low complication rates.
• Outcomes are comparable to conventional MIS-TLIF with O-arm navigation.
• Surgeons must be aware of system-related pitfalls and limitations, especially for robotic interbody cage placement; further studies on outcomes and cost-effectiveness are needed.