Robotics in Spine Surgery: The Use of Pre-op Planning to Optimize the Outcome of Spondylolisthesis Reduction

Presented at SMISS Annual Forum 2018
By Isador Lieberman MD, MBA, FRCSC
With

Disclosures: Isador Lieberman MD, MBA, FRCSC A; Mazor Robotics. B; Mazor Robotics, Stryker Spine, Globus, Misonix, Safe Orthopaedics, Medtronic, SI Bone. D; Mazor Robotics. F; Mazor Robotics

Introduction:

Robotic-assisted spine surgery has shown promising initial results by increasing the accuracy of spinal instrumentation. However, few studies have investigated the use of robotic system in the surgical treatment of spondylolisthesis.

Aims/Objectives:

To investigate the use of robotic system in the surgical treatment of spondylolisthesis.

Methods:

Data were retrospectively collected from consecutive patients who underwent lumbar fusion for degenerative L4-L5 spondylolisthesis. The robotic system was used to plan the placement of instrumentation in order to achieve the best reduction. Post-operative surgical and medical complications were reviewed. Radiological outcome was measured by L4-L5 anterior and posterior disc height, L4-L5 slippage and L4-L5 segmental lordosis. Clinical outcome was measured by the change of back pain, leg pain and ODI scores.

Results:

A total of 20 patients were included in this study. The patients’ mean age was 64 years (range 43-80) and their mean BMI was 29.0 (range 19.8 - 42.1). Robotic assisted placement of pedicle screws was carried out according to the pre-op planning in all patients. Post-operatively, one patient developed radiculopathy due to misplaced right L4 pedicle screw. All the rest pedicle screws were successfully and accurately implanted. One patient had delayed wound healing due to diabetes. At mean 17 months follow up, the patients’ mean anterior L4-L5 disc height improved from 7.5 mm to 11.2 mm (p<0.001), mean posterior L4-L5 disc height improved from 4.4 mm to 6.5 mm (p<0.01), mean L4-L5 slippage improved from 8.1 mm to 4.2 mm (p<0.001). The patients’ mean L4-L5 segmental lordosis improved from 18.0° to 22.4° but the change was not statistically significant (p=0.08). On average, the patients’ back pain VAS scores improved 4.5 points (p<0.001), leg pain VAS scores improved 5.6 points (p<0.001), ODI scores improved 19.7 points (p<0.005).

Conclusions:

For surgical treatment of adult degenerative spondylolisthesis, the use of robotic system and its pre-op planning platform is associated with satisfactory outcomes.