Simultaneous Robotic Single-Position Surgery With Oblique Lumbar Interbody Fusion With Software Planning: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Martin H Pham ◽  
Jillian Plonsker ◽  
Luis D Diaz-Aguilar ◽  
Joseph A Osorio ◽  
Ronald A Lehman
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Spinal Instrumentation ◽  
Lateral Position ◽  
Lateral Approach ◽  
Lumbar Interbody Fusion ◽  
Robotic Platform ◽  
Patient Consent ◽  
Oblique Lumbar Interbody Fusion ◽  
Lateral Interbody

Abstract The use of robotic guidance for spinal instrumentation is promising for its ability to offer the advantages of precision, accuracy, and reproducibility. This has become even more important in the era of lateral interbody surgery because spinal robotics opens up the possibility of a straightforward workflow for single-position surgery in the lateral position.  We present here a case of a 72-yr-old woman who presented with an L4-5 spondylolisthesis with axial back pain and radiculopathy. She subsequently underwent an L4-5 oblique lumbar interbody fusion with L4-5 bilateral posterior instrumentation in a single lateral position (Mazor X Stealth Edition, Medtronic Sofamor Danek, Medtronic Inc, Dublin, Ireland). Due to the oblique lateral approach and posterior robotic assistance, both surgeons were able to work simultaneously for increased efficiency. To our knowledge, this is the first video demonstrating a two-surgeon simultaneous robotic single-position surgery with oblique lumbar interbody fusion using a spinal robotic platform.  There is no identifying information in this video. Patient consent was obtained for the surgical procedure and for publishing of the material included in the video.

Minimally Invasive L5-S1 Oblique Lumbar Interbody Fusion With Simultaneous Robotic Single Position Posterior Fixation: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Martin H Pham ◽  
Mihir Gupta ◽  
Lauren E Stone ◽  
Joseph A Osorio ◽  
Ronald A Lehman
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Lateral Position ◽  
Foot Drop ◽  
Posterior Fixation ◽  
Lumbar Interbody Fusion ◽  
Patient Consent ◽  
Oblique Lumbar Interbody Fusion ◽  
Lateral Positioning

Abstract The unique anatomy at L5-S1 presents different challenges and considerations to be made when compared to other areas in the lumbar spine. In this way, the oblique lumbar interbody fusion (OLIF) is more closely related to a supine anterior lumbar interbody fusion (ALIF) except that the former is performed in a lateral position down a smaller minimally invasive retroperitoneal corridor. This lateral positioning at L5-S1, however, provides an opportunity for single-position surgery simultaneously with posterior fixation, which is not afforded by other approaches.  We present here a case of a 57-yr-old male with a prior right-sided L5-S1 microdiscectomy who presents with worsening lumbar radiculopathy and foot drop. He subsequently underwent a minimally invasive L5-S1 OLIF with posterior instrumentation placed bilaterally while remaining in a single lateral position (Mazor X Stealth Edition, Medtronic, Dublin, Ireland). Both the anterior OLIF surgeon and posterior instrumentation surgeon were able to work simultaneously. There is currently a need for further high-quality operative videos showing the L5-S1 OLIF technique, and to our knowledge, this is the first video demonstrating a 2-surgeon near-simultaneous workflow approach using a spinal robotics platform at this level.  There is no identifying information in this video. A patient consent was obtained for the surgical procedure and for publishing of the material included in the video.

scholarly journals Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Doniel Drazin ◽  
Terrence T. Kim ◽  
J. Patrick Johnson
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Posterior Instrumentation ◽  
Lateral Approach ◽  
Control Group ◽  
Percutaneous Instrumentation ◽  
Lateral Interbody Fusion ◽  
Simultaneous Group ◽  
Simultaneous Procedures ◽  
Lateral Interbody

Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes;p=0.009) and lower intraoperative blood loss: 108 mL (versus 93 mL; NS). Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS). There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

scholarly journals Oblique lumbar interbody fusion in management of lumbar degenerative spinal stenosis in Chinese population

2020 ◽  
Vol 27 (2) ◽  
pp. 119-127
Author(s):  
Man Yee Cheung ◽  
Philip Cheung
Keyword(s):  
Spinal Stenosis ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Psoas Muscle ◽  
Chinese Patients ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Lateral Incision ◽  
Oblique Lumbar Interbody Fusion ◽  
The Mean

Purpose: The purpose of this study was to assess the outcomes of a cohort of local Chinese patients who underwent oblique lumbar interbody fusion (OLIF) surgery for lumbar degenerative diseases. Methods: We adopted a minimally invasive anterior approach to the lumbar spine through retroperitoneal access. In the first part of the surgery, a 3- to 5-cm left lateral incision over the abdomen was made guided by imaging. L2–L5 disc space was approached via the corridor between the left psoas muscle and the great vessels. A specially designed interbody cage filled with bone substitute was utilized for interbody fusion. In the second part of the surgery, posterior instrumentation with or without decompression, was performed in a prone position. Efficacy and safety of the surgery were studied. Results: A total of 60 patients with the mean age of 68 years underwent OLIF at 83 surgical levels. Their mean operative time was 79 min, and the average blood loss was 84 ml for the OLIF part. The mean length of hospital stay was 5.5 days. Based on plain computed tomography scan obtained at post-operative 6 months, successful fusion was achieved in 82 of the 83 surgical levels. The Oswestry Disability Index for low back pain had a mean reduction of 22.3% after 6 months. Specific complications observed include transient thigh pain or numbness, retroperitoneal hematoma, post-operative ileus and Bone Morphogenetic Protein (BMP) osteolysis. None of the patients experienced infection, symptomatic pseudo-arthrosis, hardware failure, vascular injury, nerve injury, ureteral injury, bowel injury, incisional hernia or death. Conclusion: OLIF is an effective procedure to treat lumbar spinal stenosis and spondylolisthesis with excellent fusion rate and good functional outcome. Complications specific to this procedure are not uncommon, but majority are minor and self-recovery. Proper training is required to minimize potential surgical risks.

scholarly journals Single Position Lateral Lumbar Fusion Utilizing Robot Guided Screw Placement

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
George V Huffmon
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Structural Integrity ◽  
Lumbar Fusion ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Lateral Position ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement

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.

Oblique Lumbar Interbody Fusion From L2 to S1: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Gregory A Kuzmik ◽  
Thomas A Wozny ◽  
Simon Ammanuel ◽  
Charles M Eichler ◽  
Praveen V Mummaneni ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Deformity Correction ◽  
Lateral Position ◽  
Lumbar Interbody Fusion ◽  
Blunt Dissection ◽  
Disc Space ◽  
Vascular Surgeon ◽  
Transpsoas Approach ◽  
Oblique Lumbar Interbody Fusion ◽  
Oblique Approach

Abstract This surgical video demonstrates the technique of an oblique lumbar interbody fusion (OLIF) in the lumbar spine from L2 to L5 as well as an oblique approach to the L5-S1 level. It demonstrates the surgical approach, technical nuances of OLIF, and pearls of the surgery. The video discusses the importance of the release of the disc space to allow for height restoration and deformity correction, endplate preparation to enhance arthrodesis, and appropriate implant sizing. The concept of the approach is the minimally invasive blunt dissection through the abdominal wall musculature and mobilization of the retroperitoneal fat. Unlike the transpsoas approach, the surgery is performed anterior to the psoas, avoiding the lumbar plexus.1 For L5-S1, the approach is still performed in the lateral position but with an oblique approach. A vascular surgeon performs the L5-S1 approach, and the disc space is accessed through the iliac bifurcation.2 The discectomy and interbody fusion are performed similarly to a standard anterior lumbar interbody fusion (ALIF), but in a lateral position and at an oblique angle. The patient consented to this procedure and for filming a video of this case.

scholarly journals Analysis of The Correction Capability of Oblique Lumbar Interbody Fusion Approach to Improving The Lenke-Silva Classification in First-Stage MIS Adult Spinal Deformity Corrections

2021 ◽  
Author(s):  
Leo Shaw ◽  
Yu-Tsung Lin ◽  
Yun-Che Wu ◽  
Cheng-Min Shih ◽  
Chien-Chou Pan ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Adult Spinal Deformity ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Two Stage ◽  
Cage Subsidence ◽  
Group A ◽  
Oblique Lumbar Interbody Fusion ◽  
Group B

Abstract BackgroundA two-stage minimally invasive surgery (MIS) protocol with oblique lumbar interbody fusion (OLIF) combined with posterior instrumentation is becoming popular in the treatment of adult spinal deformities (ASDs) because of lower complication rates and less blood loss when compared with the open traditional posterior approach. The objective of this study is to determine the efficacy of correction and the causes of suboptimal correction in two-stage OLIF.MethodsThis retrospective study included 27 patients who underwent both two-stage and single-stage OLIF with posterior instrumentation for treatment of ASD. Patients treated with two-stage OLIF were sorted into Group A (Improved Lenke-Silva classification after the first-stage OLIF) and Group B (Unchanged Lenke-Silva classification after the first-stage operation) to evaluate the correction efficacy of OLIF in a two-stage MIS protocol. Statistical analyses were performed to compare the clinical and radiological outcomes. The causes of complications and suboptimal corrections (Group B) in patients treated with the two-stage MIS protocol were analyzed.ResultsAll 27 patient patients showed significant improvement (P < 0.05) in the visual analog scale, the Oswestry Disability Index, and EuroQol. A total of 14 patient were treated with the two-stage protocol, with ten patients included in group A and four patients with insufficient correction angles included in group B. The radiographic outcome of Group A showed significant corrections (P < 0.05) in pelvic tilt, pelvic incidence-lumbar lordosis (PI-LL) mismatch, sagittal vertical axis, and max Cobb angles. In group B, surgical limitations of OLIF were the cause of unsatisfactory correction in two patients because the deformities involved the T-L junction, which was not accessible using the approach. Severe preoperative PI-LL mismatch (41°) and cage subsidence with an anterior endplate fracture were the cause of poor correction in two other patients.ConclusionOLIF can provide significant corrections that reduce the need for a Smith-Petersen osteotomy (SPO) or a pedicular subtraction osteotomy (PSO) for additional correction during posterior instrumentation. Deformities involving the T-spine or T-L junction, severe PI-LL mismatches, and cage subsidence are the possible causes of suboptimal corrections with OLIF using the two-stage protocol.

Simultaneous Robotic Single Position Surgery (SR-SPS) with Oblique Lumbar Interbody Fusion: A Case Series

2021 ◽  
Author(s):  
Luis Daniel Diaz-Aguilar ◽  
Vrajesh Shah ◽  
Alexander Himstead ◽  
Nolan J. Brown ◽  
Mickey E. Abraham ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Case Series ◽  
Lumbar Interbody Fusion ◽  
Oblique Lumbar Interbody Fusion
Sign in / Sign up

Export Citation Format

Share Document