Novel Applications of Robot-Assisted Navigation in the Treatment of Lumbar
Adjacent Segment Disease: A Case Series
Rebecca Zelmanovich BS1*, Alex Lee-Norris DO2 and Praveen Reddy MD3
1College of Medicine, University of Central Florida, Orlando, FL, USA
2Department of Orthopedic Surgery, University of Central Florida College of
Medicine/HCA Healthcare Consortium, Ocala, FL, USA
3Department of Neurosurgery, University of Central Florida College of Medicine/HCA Healthcare Consortium, Ocala, FL, USA
*Corresponding Author: Rebecca Zelmanovich BS, College of Medicine, University of Central Florida, Orlando, FL, USA.
March 13, 2023; Published: April 06, 2023
Objective: The treatment of adjacent segment disease (ASD) following lumbar fusion is common and often requires reoperation. Traditionally, reoperation requires revision and exposure of prior instrumentation, and removal of this hardware increases operative time and perioperative risks. The authors report on the use of robot-assisted navigation (RAN) to accomplish minimally-invasive posterior pedicle screw fixation, including pedicle re-instrumentation when needed, to treat ASD and avoid revision and exposure of prior hardware.
Methods: A retrospective review of five patients treated for lumbar ASD with posterior fixation was conducted. All screw trajectories were planned preoperatively using the robotic software. All patients underwent minimally-invasive decompression and transforaminal lumbar interbody fusion followed by robot-assisted pedicle screw placement for fixation. Basic demographics, operative indications, pre-operative planning data, perioperative outcomes and short-term clinical outcomes were evaluated.
Results: The mean age was 71.2 years, mean total operative time was 117.6 minutes (range: 98 - 140 minutes), mean operative time per screw was 27.2 minutes, mean estimated blood loss was 30mL (range: 25 - 50 mL), mean body mass index was 36.64 (range: 26.7 - 46.9), and mean length of stay was 1.2 days (range: 1-2 days). A total of six screws were placed in previously instrumented pedicles without removing prior hardware, four in a cortical bone trajectory and two in a transpedicular trajectory (TPT). In one patient with both distal and proximal ASD, pedicle re-instrumentation was avoided altogether, creating a construct caudal, rostral and medial to index fusion. Patients were successfully treated for both single- and multi-level ASD. There were no perioperative complications. One patient was lost to follow-up. The remaining four patients had acceptable outcomes at short-term clinical follow-up.
Conclusion: The authors present a novel application of RAN for the treatment of ASD which obviates the need for revision of prior hardware. To our knowledge, this is the first report of multilevel ASD treatment that avoided revision, as well as the first report of pedicle re-instrumentation in a TPT adjacent to a prior transpedicular screw. This method maintained low operative time and acceptable perioperative outcomes. RAN may offer a minimally-invasive and effective treatment option for patients with ASD that avoids revision of prior hardware and reduces perioperative risk. Long-term clinical outcomes are warranted to ensure clinical and biomechanical durability.
Keywords: Robot-Assisted Navigation; Adjacent Segment Disease; Lumbar Spine; Degenerative Spine Disease; Robotics
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