Minimally Invasive Robotic-Guided Facetectomy and Laminectomy for Transforaminal Lumbar Interbody Fusions: Feasibility, Workflow, and Early Results

Introduction: Spinal surgery robotic platforms have improved the planning and accurate placement of pedicle screws with reduced complications related to malposition. Robotic-guided posterior facet decortication and fusion has recently been added to the robotic armamentarium. We describe for the first time a technique for spinal decompression with robotic assisted facetectomy and laminectomy.

Methods: The authors describe a novel technique and results of a consecutive series of patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), using navigation and robotic guidance to perform the facetectomy and laminectomy.

Results: A total of 9 consecutive patients underwent MI-TLIF with a tubular retractor (13 levels) using a novel navigated, robotic-guided facetectomy and laminectomy technique. Average age was 68 years. All were women. Diagnoses include spinal stenosis and spondylolisthesis, recurrent synovial cyst associated with spondylolisthesis, or facet arthropathy with nerve root compression. Surgical levels were L3-4 (3), L4-5 (8), and L5-S1 (2). Average OR time was 163 minutes. Average number of robotic guided decortications performed was 5.5 per level. 6 of the 9 patients were discharged same day from the recovery room and 3 after one night stay. There were no complications associated with the robotic-guided facetectomy and laminectomy including durotomy or nerve root injury.

Conclusion : Until now, robotic-guided techniques for performing MI-TLIFs were limited to using the robot as a precision arm guide to drill, tap, and place spinal instrumentation. With advancements in computer software and hardware, surgeons can now use spinal robotic platforms to perform other critical portions of the operation, including facet decortication and facet fusion. In this preliminary report, robotic-guided facetectomy and laminectomy was successfully performed as part of a MI-TLIF without complications. The addition of the robotic assisted spinal decompression may further improve the outcomes and reduce the complications of MI-TLIFs in the future.