Surgical Testing Comparison Utilizing ExcelsiusGPS®
Supplemental posterior fixation, following lateral lumbar interbody fusion (LLIF) utilizing conventional minimally invasive surgery (CMIS), requires the patient to be repositioned prone to provide bilateral access to the pedicles. Conversely, robot-assisted navigation (RAN) utilizing the ExcelsiusGPS® system allows for insertion of pedicle screws from a single position without repositioning the patient. RAN is theorized to reduce patient surgical time and radiation, and increase pedicle screw accuracy due to positioning and workflow effects.
Investigators used a cadaveric model to perform a two-level lateral lumbar interbody fusion (LLIF) followed by posterior bilateral pedicle screw fixation, which was inserted using CMIS or single-position RAN. Screw planning was performed using preoperative CT scans, which were merged with intraoperative fluoroscopy. Surgical time and radiation exposure were measured. Patient repositioning times from published historical data were used for comparison. RAN resulted in significantly lower surgical time and time per screw insertion compared to CMIS (P<0.05). Surgical times for preoperative RAN and CMIS were 64.7±4.1 and 123.0±13.7 minutes, respectively. Insertion time per screw for preoperative RAN and CMIS was 2.7±0.6 and 4.3±1.3 minutes, respectively. RAN and CMIS radiation dosages during posterior fixation were 0.4±0.2 and 2.7±1.6 rads, respectively (P<0.05). In conclusion, single-position RAN resulted in shorter surgical times, less radiation exposure, and fewer pedicle breaches than CMIS, which requires patient repositioning. Consideration should be given to single-position LLIF procedures that utilize RAN to instrument the spine with bilateral pedicle screws.