Single Position Lateral Lumbar Fusion Utilizing Robot Guided Screw Placement

Abstract

Abstract INTRODUCTION Lateral position interbody lumbar fusion surgery has become popular as an excellent modality for obtaining lumbar fusion and achieving sagital balance. Posterior instrumentation with pedicle screw fixation adds structural integrity to the construct. Maintaining the patient in the lateral position for pedicle screw placement decreases the time that the patient is under general anesthesia. Since August 2017 we have successfully performed 32 single position pedicle screw fixations utilizing robotic guidance. METHODS The lateral position was utilized for interbody fusion using a variety of techniques; oblique lumbar interbody fusion, extreme lateral lumbar interbody fusion, and lateral anterior lumbar interbody fusion. The Mazor X robot (Medtronic) was utilized for guidewire placement maintaining the patient in the lateral position. Pedicle screws of various manufacturers were placed over the guide wires and connecting rods were placed in the lateral position. RESULTS Since August 2017 we have successfully placed pedicle screws in 1 and 2 level single position lateral lumbar fusions in 32 of 39 cases attempted. There were no nerve root injuries nor any complications related to pedicle screw placement. CONCLUSION Single position lateral lumbar fusion cases utilizing robotic guidance for pedicle screw placement is a viable surgical procedure. Placement of the pedicle screws in the lateral position can reduce intraoperative anesthetic time by eliminating the placement of the patient into the prone position. Utilization of robotic guidance can decrease intraoperative fluoroscopy exposure.