Robotic-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Area of Science:

• Spine Surgery
• Minimally Invasive Techniques
• Robotics in Medicine

Background:

• Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) requires radiographic guidance for accurate pedicle screw placement due to lack of direct visualization.
• Robotic-assisted (RA) systems offer potential for enhanced accuracy through robotic-arm guidance along planned trajectories.
• RA MI-TLIF combines robotic assistance with minimally invasive surgery to improve outcomes for lumbar degenerative pathologies.

Purpose of the Study:

• To evaluate the efficacy and outcomes of robotic-assisted minimally invasive transforaminal lumbar interbody fusion (RA MI-TLIF).
• To compare RA MI-TLIF with traditional fluoroscopy-guided and open surgical techniques.
• To highlight the advantages of robotic guidance in improving instrumentation accuracy and minimizing invasiveness.

Main Methods:

• Patients undergo general anesthesia in a prone position with reference arrays for intraoperative CT and robotic instrument calibration.
• Surgical planning is performed using robotic interface software for screw and cage placement.
• Percutaneous pedicle screws are placed using a robotic arm, followed by discectomy, cage insertion, and percutaneous rod placement.

Main Results:

• RA screw placement demonstrates higher accuracy, with lower rates of pedicle wall penetration and facet joint invasion compared to fluoroscopy.
• RA MI-TLIF shows reduced blood loss, shorter length of stay, and better patient-reported outcomes compared to open TLIF.
• RA MI-TLIF has similar fusion rates to fluoroscopy-assisted MI-TLIF but with greater accuracy, fewer complications, and less radiation exposure.

Conclusions:

• Robotic-assisted minimally invasive transforaminal lumbar interbody fusion (RA MI-TLIF) is a safe and effective technique for lumbar degenerative pathologies.
• RA MI-TLIF offers significant advantages over fluoroscopy-guided and open procedures, including improved accuracy and reduced complications.
• The use of robotic guidance enhances surgical precision and minimizes invasiveness in TLIF procedures.