Robot-assisted multi-level anterior lumbar interbody fusion: an anatomical study.

Abstract:

BACKGROUND:Minimally invasive surgical approaches still provide limited exposure. Access to the L2-L5 intervertebral discs during a single procedure is challenging and often requires repositioning of the patient and adopting an alternative approach. OBJECTIVES:Investigate the windows to the L2-L5 intervertebral discs to assess the dimensions of the interbody implants suitable for the procedure and evaluate the feasibility of multi-level lumbar intervertebral disc surgery in robot-assisted surgery (RAS) METHODS: Sixteen fresh-frozen cadaveric specimens underwent a retroperitoneal approach to access the L2-L5 intervertebral discs. The L2-L3 to L4-L5 windows were defined as the distance between the left lateral border of the aorta (or nearest common iliac vessel) and the medial border of the psoas, measured in a static state and after gentle medial retraction of the vascular structures. Two living porcine specimens and one cadaveric specimen underwent da Vinci robot-assisted transperitoneal approach to expose the L2-L3 to L4-L5 intervertebral discs and perform multi-level discectomy and interbody implant placement. RESULTS:The L2-L3 to L4-L5 intervertebral disc windows significantly increased from a static to a retracted state (p < 0.05). The mean L2-L3, L3-L4, and L4-L5 windows measured respectively 20.1, 21.6, and 19.6 mm in the static state, and 27.2, 30.9, and 30.3 mm after gentle vascular retraction. The intervertebral windows from L2-L3 to L4-L5 were successfully exposed through an anterior transperitoneal approach with the da Vinci robot on the cadaveric and living porcine specimens, and interbody implants were inserted. CONCLUSION:RAS appears to be feasible for a mini-invasive multi-level lumbar intervertebral disc surgery. The RAS procedure, longer and more expensive than conventional MIS approaches, should be reserved for elective patients.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Troude L,Boissonneau S,Malikov S,Champsaur P,Blondel B,Dufour H,Fuentes S

doi

10.1007/s00701-018-3621-x

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

1891-1898

issue

10

eissn

0001-6268

issn

0942-0940

pii

10.1007/s00701-018-3621-x

journal_volume

160

pub_type

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