Robotics planning in minimally invasive surgery for adult degenerative scoliosis: illustrative case

Abstract

BACKGROUND Minimally invasive surgical techniques are changing the landscape in adult spinal deformity (ASD) surgery, enabling surgical correction to be achievable in increasingly medically complex patients. Spinal robotics are one technology that have helped facilitate this. Here the authors present an illustrative case of the utility of robotics planning workflow for minimally invasive correction of ASD. OBSERVATIONS A 60-year-old female presented with persistent and debilitating low back and leg pain limiting her function and quality of life. Standing scoliosis radiographs demonstrated adult degenerative scoliosis (ADS), with a lumbar scoliosis of 53°, a pelvic incidence–lumbar lordosis mismatch of 44°, and pelvic tilt of 39°. Robotics planning software was utilized for preoperative planning of the multiple rod and 4-point pelvic fixation in the posterior construct. LESSONS To the authors’ knowledge, this is the first report detailing the use of spinal robotics for complex 11-level minimally invasive correction of ADS. Although additional experiences adapting spinal robotics to complex spinal deformities are necessary, the present case represents a proof-of-concept demonstrating the feasibility of applying this technology to minimally invasive correction of ASD.

Spinal Robotics in Adult Spinal Deformity Surgery: A Systematic Review

“…Of 14 unique studies screened against title and abstract, 12 met criteria for full-text analysis, of which 5 studies comprising 138 patients (61.6% female; mean age, 66.0 years) were ultimately included [ 12 , 13 , 16 - 18 ]. The most common reasons for study exclusion were inclusion of non-ASD patients within the study cohort (n= 3) [ 14 , 22 , 23 ] and failure to report one of the prespecified outcome measures (n= 3) [ 9 , 24 , 25 ] ( Fig. 1 ).…”

“…However, limited studies have compared the efficacy of robotically placed S2 alar-iliac (S2AI) screws in ASD surgery to freehand techniques [ 8 ]. Modern iterations of spinal robotic systems utilize advanced planning software that can plan screw entry points to facilitate rod passage and incorporate the expected alignment changes based on osteotomy placement [ 9 , 10 ]. These devices consequently hold the potential to advance both open and minimally invasive (MIS) ASD correction [ 5 , 11 , 12 ].…”

Oblique anterior column realignment with a mini-open posterior column osteotomy for minimally invasive adult spinal deformity correction: illustrative case

“…Advances in minimally invasive surgical technology, including preoperative planning software, 10 spinal robotics, percutaneous instrumentation systems, 19 and anterolateral/lateral approaches for interbody placement have significantly broadened the indications for minimally invasive approaches in ASD surgery. The present case helps to illustrate this by highlighting the application of a grade 2 ACR through an oblique antepsoas approach (OLIF).…”

“… 7 Autofusion across the disc spaces and asymmetrical disc height loss can lead to coronal as well as sagittal malalignment. 9 , 10 Surgical correction is technically difficult and has conventionally focused on invasive, open posterior-only approaches with multilevel osteotomies, which often have a morbid complication profile. 11 , 12 This risk profile is further exacerbated in the ASD population, which commonly has extensive health comorbidities including diabetes, frailty, obesity, osteoporosis, and limited mobility in the setting of their disability.…”

Endoscopic Anterior Lumbar Interbody Fusion: Systematic Review and Meta-Analysis

“…Excellent footprint for implants and strong fusion rates for ALIF (in general terms) aside [ 34 ], the results of this study indicate that L-ALIF affords much lower overall rates of fusion (pooled rate: 78.9%) compared to the other ALIF techniques (typical fusion rates: 85%–95%) [ 35 ]. Again, L-ALIF is historically not the most successful technique, but with improved technology in the form of modern endoscopy and robotic guidance and neuronavigation, endoscopy may gain further traction for ALIF down the line [ 36 ].…”