[Robotically assisted and minimally invasive pedicle screw placement at the lumbar spine].

Abstract

Objectives of the surgery: The aim of this operation technique is to bridge the pathological fracture of a vertebral body by a dorsal spondylodesis, to stabilize the spine, reduce the pain and regain mobility.

Indications: Due to the vertebral body fracture (OF 2) of the third lumbar vertebral body (L3) and the associated pain and immobility and due to the modified score of the AO Spine-DGOU osteoporotic fracture (OF) classification system.

Contraindications: No specific contraindications.

Surgical technique: Technical set-up: Robotic Suite (Brainlab, Munich, Germany) with navigation unit "curve navigation system", robotic 3D cone beam computed tomography (CBCT) "Loop-X", robotic arm "Cirq Arm System" and wall-mounted monitor "BUZZ". Operation steps are shown in the video (English): Planning of the screws based on preoperative CT imaging. Placement of the reference array. First imaging, image fusion and fusion control. Registration of instruments. Robotically assisted skin incision planning. Robotically assisted drilling. K-wire insertion. Second imaging and wire position check. Screw placement. Cement augmentation of the screws. Insertion of the connecting rods. Wound closure.

Follow-up: Full weight bearing, pain medication if required. Physiotherapeutic treatment to learn strengthening exercises and restoration of mobility. Medication with vitamin D3 and calcium. Metal removal is not intended.

Evidence: Operations on the lumbar spine are now routine clinical practice in orthopedics and trauma surgery. They can be performed without any problems and with very good accuracy in terms of precise screw placement.