Step-by-step guide to robotic-guided minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)


doi: 10.21037/atm-22-3273.


Epub 2022 Dec 22.

Affiliations

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J Manuel Sarmiento et al.


Ann Transl Med.


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Abstract

Robotics in spinal surgery offers a promising potential to refine and improve the minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) technique. Suitable surgeons for this technique include those who are already familiar with robotic-guided lumbar pedicle screw placement and want to advance their skillset by incorporating posterior-based interbody fusion. We provide a step-by-step guide for robotic-guided MI-TLIF. The procedure is divided into 7 practical and detailed techniques. The steps in sequential order include: (I) planning trajectories for pedicle screws and the tubular retractor; (II) robotic-guided pedicle screw placement; (III) placement of tubular retractor; (IV) unilateral facetectomy using the surgical microscope; (V) discectomy & disc preparation; (VI) interbody implant insertion; and (VII) percutaneous rod placement. We standardize surgeon training in robotic MI-TLIF by teaching our spine surgery fellows these 7 key technical steps highlighted in this guide. Current-generation robotics offers integrated navigation capability, K-wireless placement of pedicle screws through a rigid robotic arm, compatibility with tubular retractor systems to perform facetectomy, and allows for placement of interbody devices. We have found robotic-guided MI-TLIF to be a safe procedure that allows for accurate and reliable pedicle screw placement, less collateral damage to the soft tissues of the low back, and decreased radiation exposure.


Keywords:

Robotic spine surgery; TLIF; minimally invasive spine surgery; minimally invasive transforaminal lumbar interbody fusion (MI-TLIF); transforaminal interbody lumbar fusion.

Conflict of interest statement

Conflicts of Interests: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-3273/coif). SAQ serves as an unpaid Editorial Board Member of Annals of Translational Medicine from September 2021 to August 2023. SAQ also reports that he works for Globus Medical as paid presenter or speaker, consultant and receives royalties. The other authors have no conflicts of interest to declare.

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