Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2023 Dec;180:29-35. doi: 10.1016/j.wneu.2023.09.028. Epub 2023 Sep 13.
Minimally invasive approaches to the spine via anterior and posterior approaches have been increasing in popularity, culminating in the development of robot-assisted spinal fusions. The da Vinci surgical robot has been used for anterior lumbar interbody fusion (ALIF), with promising results. Similarly, multiple spinal robots have been developed to assist placement of posterior pedicle screws. However, no previous cases have reported on using robots for both anterior and posterior fixation in a single surgery. We present a technical note on the first reported case of a totally robotic minimally invasive anterior and posterior lumbar fusion and instrumentation.
A 65-year-old man with chronic low back pain and left greater than right lower extremity radiculopathy was found to have grade 1 spondylolisthesis at L5/S1 that worsened on standing upright. He underwent ALIF using a da Vinci robotic approach, followed by percutaneous posterior instrumented fusion with the Globus Excelsius GPS robot.
The patient did well postoperatively, with improvement of back and leg pain at 3 months follow-up. Radiography confirmed appropriate placement of the interbody cage and pedicle screws.
All-robotic placement of both ALIF and posterior lumbar pedicle fixation may be safe, feasible, and efficacious.
经前路和后路的微创入路方法治疗脊柱疾病的应用越来越广泛，最终发展为机器人辅助脊柱融合术。达芬奇手术机器人已被用于前路腰椎间融合术（ALIF），并取得了良好的效果。同样，也开发了多种脊柱机器人来辅助后路椎弓根螺钉的植入。然而，以前没有报道过在单次手术中同时使用机器人进行前路和后路固定的病例。我们报道了首例使用机器人进行全微创前路和后路腰椎融合及内固定的病例，并介绍了相关技术。
一名 65 岁男性，因慢性腰痛和左下肢比右下肢更严重的神经根病就诊，被发现 L5/S1 存在 1 级脊椎滑脱，直立时加重。他接受了达芬奇机器人辅助前路手术（ALIF），随后进行了经皮后路器械融合，使用的是 Globus Excelsius GPS 机器人。
患者术后恢复良好，在 3 个月随访时腰痛和腿痛均有改善。影像学检查证实了椎间融合器和椎弓根螺钉的位置合适。
全机器人辅助进行 ALIF 和后路腰椎椎弓根固定可能是安全、可行和有效的。
