Minimally Invasive Robotic-Guided Facetectomy and Laminectomy for Transforaminal Lumbar Interbody Fusions: Feasibility, Workflow, and Early Results

Abstract

OBJECTIVE: Robotic-guided techniques for spinal fusions have improved pedicle screw accuracy, reduced radiation exposure, and minimized complications. Recently, robotic-guided posterior facet decortication and fusion have been introduced. However, no techniques have utilized robotic platforms for spinal decompression procedures such as facetectomy and laminectomy. This study demonstrates the safe and effective integration of robotic-assisted laminectomy into a minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) workflow. METHODS: A retrospective review was conducted on patients who underwent MI-TLIF using navigation and robotic guidance for facetectomy and laminectomy. The University of Arizona IRB approved the study (STUDY00004352). RESULTS: Nine consecutive patients (13 levels) underwent MI-TLIF using a novel robotic-guided facetectomy and laminectomy technique. The average age was 68 years, and all were women. Most were treated for spinal stenosis with spondylolisthesis, synovial cysts, or facet arthropathy. Treated levels included L3-L4 (3), L4-L5 (8), and L5-S1 (2). The average operative time was 163 minutes, with 5.5 decortications per level. Six patients were discharged from the recovery room, while 3 required an overnight stay. No complications, including durotomy or nerve root injury, occurred. CONCLUSIONS: This preliminary study demonstrates that robotic-guided facetectomy and laminectomy can be safely incorporated into MI-TLIF. With advancements in robotic technology, further expansion to interbody preparation, cage placement, and rod delivery may enhance surgical precision and outcomes. Future research is necessary to optimize robotic-assisted spinal surgery.