Robotics planning in minimally invasive surgery for adult degenerative scoliosis: illustrative case

Abstract

Background: Minimally invasive surgical techniques are changing the landscape in adult spinal deformity (ASD) surgery, enabling surgical correction to be achievable in increasingly medically complex patients. Spinal robotics are one technology that have helped facilitate this. Here the authors present an illustrative case of the utility of robotics planning workflow for minimally invasive correction of ASD.

Observations: A 60-year-old female presented with persistent and debilitating low back and leg pain limiting her function and quality of life. Standing scoliosis radiographs demonstrated adult degenerative scoliosis (ADS), with a lumbar scoliosis of 53°, a pelvic incidence-lumbar lordosis mismatch of 44°, and pelvic tilt of 39°. Robotics planning software was utilized for preoperative planning of the multiple rod and 4-point pelvic fixation in the posterior construct.

Lessons: To the authors' knowledge, this is the first report detailing the use of spinal robotics for complex 11-level minimally invasive correction of ADS. Although additional experiences adapting spinal robotics to complex spinal deformities are necessary, the present case represents a proof-of-concept demonstrating the feasibility of applying this technology to minimally invasive correction of ASD.

Keywords: ASD; adult degenerative scoliosis; adult spinal deformity; minimally invasive; minimally invasive surgery; robotics.

FIG. 1.

Anteroposterior (left) and lateral (right) radiographs demonstrating adult degenerative scoliosis with associated sagittal imbalance.

FIG. 2.

Intraoperative image of the lateral incisions used for the first stage T12–S1 oblique lumbar interbody fusion. Insets demonstrate the intraoperative fluoroscopy image with all 6 interbodies with the T12–L4 cages placed through the proximal 7-cm incision and the L4–S1 cages placed through the distal 6-cm incision.

FIG. 3.

A: Predictive software plan compared with standing anteroposterior lumbar radiograph after the first-stage T12–S1 oblique lumbar interbody fusions. B: Predictive software plan compared with standing lateral lumbar radiograph after the first-stage T12–S1 oblique lumbar interbody fusions.

FIG. 4.

A: Lateral and anteroposterior software plan showing 2 planar main rods from T9–S2 with a left T12 satellite rod and a right L2 and L3 satellite rod, both of which have separate connections to additional iliac screws. B: A 3D reconstruction of the plan with percutaneous towers for additional granular planning to ensure there are no tower collisions at L4–S2 due to convergence at the expected lumbar lordosis.

FIG. 5.

A: Intraoperative long-film radiograph showing percutaneous placement of all screws with the screw towers connecting the satellite rods already removed. B: Intraoperative image showing minimally invasive percutaneous placement of screws and 3 rod passers in view.