Robotically Assisted Laparoscopic Anterior Lumbar Interbody Fusion

Introduction: Laparoscopic anterior lumbar interbody fusion(ALIF) has the advantage of providing immediate stability to the lumbar spine via a minimally invasive approach. Voice activated robot for camera control provides the surgeon with excellent control over the visual field.

Methods: All patients (n=26) undergoing robotically assisted single–level laparoscopic L5–SI ALIF between Aug–97 and Sept–98 using carbon– fiber spacers with autograft, without posterior stabilization were included. Seven patients had prior back surgery. There were 9 males and 17 females. Average age was 44 years. Average follow–up was 20.2 months.

Results: In patients with solid fusion (n=14), mean lumbosacral lordosis increased from 18.8 degrees to 28.0 degrees and mean disc height increased from 7.3mm to 10.7mm at latest follow–up. In patients with pseudoarthrosis (n=l2), initial increased lordosis (20.9 degrees to 25.6 degrees) and disc height (9.4mm to 12.4mm) gradually decreased to preoperative level by 12 months. Salvage posterior fusion and instrumentation was performed in 12 patients with settling (greater than 2mm) and pseudoarthrosis. There were no vascular or neurological complications. At latest follow–up, 20 patients said they were better than before surgery.

Discussion: Laparoscopic ALIF is an effective alternative to open ALIF with lesser morbidity and shortened hospital stay. Settling of the intradiscal spacer presents a challenge in stand–alone fusion. Improved patient selection and implant design and supplemental posterior stabilization may help improve the results. Robotic assistance decreases the need for trained personnel, reduces inadvertent camera movements resulting from human fatigue error, allowing greater freedom to the operating surgeon and assistant.