Garufi Giada, Conti Alfredo, Collufio Domenicantonio, Messineo Francesco, Morabito Antonio, Ricciardo Giuseppe, Cardali Salvatore
Neurosurgery, Papardo Hospital, University of Messina, Messina, ITA.
Neurosurgery, University of Bologna, Bologna, ITA.
Cureus. 2025 Apr 22;17(4):e82802. doi: 10.7759/cureus.82802. eCollection 2025 Apr.
To assess the early clinical and radiological outcomes of the midline lumbar interbody fusion (MIDLIF) approach with the use of robotic assistance and expandable spacers.
A retrospective case series was performed on patients who underwent MIDLIF procedures for the treatment of degenerative spinal diseases, with a minimum of three months postoperative follow-up. Demographic (age, gender, body mass index [BMI], comorbidities, and diagnoses), surgical data (operative time, blood loss, hospital stay, intraoperative complications), patient-reported outcomes (PROs) (visual analogue scale [VAS] back pain and disability (Oswestry disability index [ODI]), and radiographic data were collected.
In total, 42 patients were included, with an average age of 53.6 years and a BMI of 28 kg/m². Surgical data showed the mean total operative time was 98.8 minutes, and the mean blood loss was 17.1 mL with no intraoperative complications. At three-month follow-up, all mean PROs showed statistically significant improvement (p<0.05) when compared with baseline. VAS back pain improved from 7.5 (standard deviation (stdev) 7.5±0.7) preoperatively to 3.0 (stdev 1.0) at three months postoperative, while ODI improved from 58.7 (stdev 7.2) to 26.3 (stdev 10.3) at the same time points. Radiographic data showed that using robotic assistance for planning and placing cortical screws yielded high accuracy, as evidenced by a mean tip deviation of 1.2 mm (stdev 0.6 mm), mean tail deviation of 1.1 mm (stdev 0.4 mm) and a mean angular offset of 1.4 mm (stdev 0.7). Two (4.8%) patients had postoperative complications at three-month follow-up, including a wound infection and one report of wound dehiscence.
MIDLIF is an efficient, reproducible surgical procedure with a low complication rate that resulted in significant improvements in early PROs. Robotic assistance for planning and placing cortical screws in MIDLIF was highly accurate. These initial findings suggest that using robotic assistance adds value to MIDLIF procedures and is a viable alternative to traditional posterior fusion procedures.
评估使用机器人辅助和可扩张椎间融合器的腰椎前路椎间融合术（MIDLIF）的早期临床和影像学结果。
对接受MIDLIF手术治疗退行性脊柱疾病的患者进行回顾性病例系列研究，术后随访至少3个月。收集人口统计学资料（年龄、性别、体重指数[BMI]、合并症和诊断）、手术数据（手术时间、失血量、住院时间、术中并发症）、患者报告结局（PROs）（视觉模拟评分法[VAS]背痛和功能障碍（Oswestry功能障碍指数[ODI]））以及影像学数据。
共纳入42例患者，平均年龄53.6岁，BMI为28kg/m²。手术数据显示，平均总手术时间为98.8分钟，平均失血量为17.1mL，无术中并发症。在3个月随访时，所有平均PROs与基线相比均有统计学意义的改善（p<0.05）。VAS背痛从术前的7.5（标准差（stdev）7.5±0.7）改善至术后3个月的3.0（stdev 1.0），而ODI在相同时间点从58.7（stdev 7.2）改善至26.3（stdev 10.3）。影像学数据显示，使用机器人辅助进行皮质骨螺钉的规划和置入具有很高的准确性，平均尖端偏差为1.2mm（stdev 0.6mm），平均尾部偏差为1.1mm（stdev 0.4mm），平均角度偏移为1.4mm（stdev 0.7）。2例（4.8%）患者在3个月随访时有术后并发症，包括1例伤口感染和1例伤口裂开报告。
MIDLIF是一种高效、可重复的手术方法，并发症发生率低，可使早期PROs得到显著改善。机器人辅助在MIDLIF中进行皮质骨螺钉的规划和置入具有很高的准确性。这些初步研究结果表明，使用机器人辅助可为MIDLIF手术增加价值，是传统后路融合手术的可行替代方案。
