Robot-assisted minimally invasive transforaminal interbody fusion: a complete workflow pilot feasibility study

Background: Robotic-assisted spinal surgery has reportedly improved the accuracy of instrumentation with smaller incisions, improving surgical outcomes and reducing hospital stay. However, robot-assisted spine surgery has thus far been confined to placement of pedicle screw instrumentation only. This pilot study aims to explore the feasibility of utilizing the Mazor™ X Stealth Edition (Medtronic, Sofamor Danek USA), robotic-arm platform in the minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) procedure inclusive of interbody cage placement, in our institution. Methods: Single-centre, single surgeon prospectively collected case series of 29 patients who were planned for robot-assisted MIS-TLIF (RA-TLIF) with Mazor™ X Stealth system, on patient demographics [age, gender, body mass index (BMI), Charlson Comorbidity Index (CCI)], and post-operative outcomes. Results: Of the 29 RA-TLIF cases planned, 2 cases were excluded due to software start-up issues. One patient underwent revision surgery for posterior-migrated interbody cage. No loosening of posterior instrumentation was seen in all cases at 6 months follow-up. Conclusions: Our single-institution pilot study on the Mazor™ X Stealth RA-TLIF has shown high pedicle screw insertion accuracy and relatively low complication rates, comparable to that of conventional MIS-TLIF O-arm navigation system. However, the discerning surgeon should be on the lookout for potential system-related pitfalls, as well as understand the limitations for robotic interbody cage placement. Further studies will also be required on patient outcomes and cost-effectiveness prior to consideration for wide scale implementation.