Fellow Cleveland Clinic Florida, Florida, United States
Introduction: Minimally invasive surgery posterior instrumental fusion (MIS-PIF) of the cervical spine (C-spine) remains challenging for neurosurgeons worldwide. While the advantages of MIS have been well described in the literature, there is not enough evidence supporting robot-assisted surgery of the C-spine. The authors present their experience with robot-assisted C-spine surgery and aim to highlight the technical nuances and benefits of this procedure.
Methods: Twenty-five patients who underwent robot-assisted (ExcelsiusGPS-Globus Medical) cervical spine PIF between April 2018 to February 2020 were included in this study. Demographic data such as age, sex, BMI, indication for surgery, length of hospital stay, and complications were collected retrospectively for each patient via manual chart review. The intraoperative time and blood loss for each procedure were also recorded. Patients were followed up for one year post-operatively. The authors also describe the operative setup, patient positioning, and intra-operative technical aspects.
Results: This study included 10 females and 15 males, with a mean BMI of 30±7. Indications for surgery included degenerative joint disease (64%), trauma (32%), and tumor (4%). Successful MIS-PIF robot-assisted was obtained in all 25 cases, with no intraoperative complications reported. The number of screws placed with MIS robot-assisted on each level was, C1 lateral mass (3), C2 pars (3), C1-2 trans-articular (3), C3 (26), C4 (30), C5(36), C6(36), and C7(42) respectively. The mean operating time was 277±75 minutes, and the estimated blood loss was 167±108 ml. On average, patients stayed at the hospital for 1 day post-operatively. All patients reported a considerable reduction in pain and analgesic usage at each follow-up visit.
Conclusion : Robot-assisted MIS-PIF may offer many benefits compared to traditional open and standard MIS techniques. The association with robotic technology might be advantageous in terms of navigation, screw and retractor placement, incision minimization, shorter post-operative length of stay, and reduced complications, such as intra-operative blood loss and vascular injury. Furthermore, it may be associated with reduced postoperative pain and improved quality of rehabilitation in these patients.
