Single position L5-S1 lateral ALIF with simultaneous robotic posterior fixation is safe and improves regional alignment and lordosis distribution index

Nicholas S Hernandez; L Daniel Diaz-Aguilar; Martin H Pham

doi:10.1007/s00586-023-07841-y

Single position L5-S1 lateral ALIF with simultaneous robotic posterior fixation is safe and improves regional alignment and lordosis distribution index

Eur Spine J. 2023 Jul 15. doi: 10.1007/s00586-023-07841-y. Online ahead of print.

Authors

Nicholas S Hernandez¹, L Daniel Diaz-Aguilar¹, Martin H Pham^{2

3}

Affiliations

¹ Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA.
² Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA. mhpham@health.ucsd.edu.
³ Department of Neurosurgery, UC San Diego Health, 9300 Campus Point Drive, MC7893, La Jolla, CA, 92037, USA. mhpham@health.ucsd.edu.

PMID: 37452837
DOI: 10.1007/s00586-023-07841-y

Abstract

Purpose: Minimally invasive single position lateral ALIF at L5-S1 with simultaneous robot-assisted posterior fixation has technical and anatomic considerations that need further description.

Methods: This is a retrospective case series of single position lateral ALIF at L5-S1 with robotic assisted fixation. End points included radiographic parameters, lordosis distribution index (LDI), complications, pedicle screw accuracy, and inpatient metrics.

Results: There were 17 patients with mean age of 60.5 years. Eight patients underwent interbody fusion at L5-S1, five patients at L4-S1, two patients at L3-S1, and one patient at L2-S1 in single lateral position. Operative times for 1-level and 2-level cases were 193 min and 278 min, respectively. Mean EBL was 71 cc. Mean improvements in L5-S1 segmental lordosis were 11.7 ± 4.0°, L1-S1 lordosis of 4.8 ± 6.4°, sagittal vertical axis of - 0.1 ± 1.7 cm°, pelvic tilt of - 3.1 ± 5.9°, and pelvic incidence lumbar-lordosis mismatch of - 4.6 ± 6.4°. Six patients corrected into a normal LDI (50-80%) and no patients became imbalanced over a mean follow-up period of 14.4 months. Of 100 screws placed in lateral position with robotic assistance, there were three total breaches (two lateral grade 3, one medial grade 2) for a screw accuracy of 97.0%. There were no neurologic, vascular, bowel, or ureteral injuries, and no implant failure or reoperation.

Conclusion: Single position lateral ALIF at L5-S1 with simultaneous robotic placement of pedicle screws by a second surgeon is a safe and effective technique that improves global alignment and lordosis distribution index.

Keywords: Anterior lumbar interbody fusion (ALIF); L5-S1; Lateral surgery; Lordosis distribution index; Mazor X Stealth Edition; Minimally invasive surgery; Oblique lumbar interbody fusion (OLIF); Single position surgery; Spinal robotics.