Single-Position Lateral Lumbar Interbody Fusion Using Robotically Assisted Percutaneous Pedicle Screw Fixation in the Lateral Decubitus Position: Preliminary Results and Nuances of an Emerging Technology

Introduction: This study reports a single-institution experience with robotically assisted single-position surgery for pedicle screw fixation and lateral lumbar interbody fusion in the lateral decubitus position (SL-ROB). Treatment outcomes, screw accuracy, and safety profile are discussed and compared with those of computed tomography-navigated surgery (SL-NAV). Methods: A retrospective analysis of prospectively collected data was performed for all patients who underwent SL-ROB and SL-NAV from May 2018 to February 2020 at our institution (Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ). Data on patient demographics, intraoperative details, the accuracy of screw placement, radiation dose, and outcomes were collected. Continuous variables were compared using the Mann-Whitney U test, and categorical variables were compared using the χ2 test. Results: Seventeen patients (nine women and eight men) were enrolled. Ten underwent SL-ROB (mean (SD) age, 68.5 (7.5) years), and seven underwent SL-NAV (mean (SD) age, 59.0 (8.6) years). For the SL-ROB group, 11 levels were fused, and 40 pedicle screws were placed. The mean (SD) total operative duration, robot time, and time per screw were 4.6 (1.3) hours, 78 (48) minutes, and 7.0 (6.8) minutes, respectively. There were two instances of breach, and 32 of 34 (94%) screws had acceptable placement. Comparison of the SL-ROB and SL-NAV cohorts did not show significant differences in the mean operative time (p = 0.44) or treatment outcomes. Conclusions: This series illustrates the efficiency and safety of SL-ROB. In comparison with SL-NAV, SL-ROB was associated with a similar operative time and improved screw placement accuracy. Operative efficiency improved over time in the SL-ROB cohort.