Robot-assisted multi-level anterior lumbar interbody fusion: an anatomical study View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2018-10

AUTHORS

Lucas Troude, Sébastien Boissonneau, Segueï Malikov, Pierre Champsaur, Benjamin Blondel, Henry Dufour, Stéphane Fuentes

ABSTRACT

BACKGROUND: Minimally invasive surgical approaches still provide limited exposure. Access to the L2-L5 intervertebral discs during a single procedure is challenging and often requires repositioning of the patient and adopting an alternative approach. OBJECTIVES: Investigate the windows to the L2-L5 intervertebral discs to assess the dimensions of the interbody implants suitable for the procedure and evaluate the feasibility of multi-level lumbar intervertebral disc surgery in robot-assisted surgery (RAS) METHODS: Sixteen fresh-frozen cadaveric specimens underwent a retroperitoneal approach to access the L2-L5 intervertebral discs. The L2-L3 to L4-L5 windows were defined as the distance between the left lateral border of the aorta (or nearest common iliac vessel) and the medial border of the psoas, measured in a static state and after gentle medial retraction of the vascular structures. Two living porcine specimens and one cadaveric specimen underwent da Vinci robot-assisted transperitoneal approach to expose the L2-L3 to L4-L5 intervertebral discs and perform multi-level discectomy and interbody implant placement. RESULTS: The L2-L3 to L4-L5 intervertebral disc windows significantly increased from a static to a retracted state (p < 0.05). The mean L2-L3, L3-L4, and L4-L5 windows measured respectively 20.1, 21.6, and 19.6 mm in the static state, and 27.2, 30.9, and 30.3 mm after gentle vascular retraction. The intervertebral windows from L2-L3 to L4-L5 were successfully exposed through an anterior transperitoneal approach with the da Vinci robot on the cadaveric and living porcine specimens, and interbody implants were inserted. CONCLUSION: RAS appears to be feasible for a mini-invasive multi-level lumbar intervertebral disc surgery. The RAS procedure, longer and more expensive than conventional MIS approaches, should be reserved for elective patients. More... »

PAGES

1891-1898

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00701-018-3621-x

DOI

http://dx.doi.org/10.1007/s00701-018-3621-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1105777994

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30039290


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