Name:
10.3171/2025.4.FOCVID2522
Description:
10.3171/2025.4.FOCVID2522
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/893eca8c-91cd-4a5c-bd16-ebd500bc7649/videoscrubberimages/Scrubber_212.jpg
Duration:
T00H06M10S
Embed URL:
https://stream.cadmore.media/player/893eca8c-91cd-4a5c-bd16-ebd500bc7649
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/893eca8c-91cd-4a5c-bd16-ebd500bc7649/9. 25-22.mp4?sv=2019-02-02&sr=c&sig=be4cdufwhw0XdEOGp%2FGCqbixY4f%2FhMAXuGaTGCwYZjU%3D&st=2025-10-15T18%3A48%3A32Z&se=2025-10-15T20%3A53%3A32Z&sp=r
Upload Date:
2025-05-30T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER: Here we present a case with the use of robotic assistance for the reduction of a grade 2 isthmic spondylolisthesis through a posterior approach. The patient is a 62-year-old female with a medical history significant for stage 4 metastatic breast cancer. She had undergone double mastectomy and radiation treatment, including to the lumbar spine. She is currently on immunotherapy and hormonal therapy.
SPEAKER: She also had a hysterectomy. She has osteoporosis that is currently being treated The patient presented with low back pain and bilateral lower extremity radiculopathy that she rated as a 10 on the numeric rating scale. She had trialed conservative measures, including physical therapy and epidural injections with no significant improvement. She had multiple hospitalizations for pain control and due to falls from left leg weakness when ambulating.
SPEAKER: Her physical exam was notable for diffuse weakness in the left leg secondary to pain. CT and MRI scan of the lumbar spine showed bilateral pars defects at L5 and grade 2 spondylolisthesis at L5–S1 with severe degenerative endplate changes. The arrow shows the left-sided severe foraminal stenosis correlating to the patient's radiating leg pain.
SPEAKER: Because the patient had prior abdominal surgery and radiation treatment, a posterior-only approach was recommended for reduction in the form of an L4 to S2-A-I fusion with cement augmentation of the L4 screws due to the poor bone quality from osteoporosis, bony metastasis, and prior radiation treatment. Robotic-assisted surgery was beneficial in this case because it ensured the proper placement of hardware to avoid multiple passes in a patient with poor bone quality and because it allowed the surgeons to preplan the surgery to allow for the least invasive possible procedure in a patient who would not be able to tolerate an open procedure with high blood loss.
SPEAKER: Key surgical steps are listed in this slide. The most important steps of the surgery include use of the robotic navigation platform for hardware placement and to guide decompression, cement augmentation of the L4 screws to prevent pullout, and reduction of the spondylolisthesis via tandem tightening of the facet screws, as well as sequential expansion of a temporary cage.
SPEAKER: Once the patient has been positioned, intraoperative CT has been performed and loaded to the robot. Operative planning of the fusion construct is performed. The position of each screw is assessed, along with the overall alignment of the construct.
SPEAKER: The robot is then draped and brought into the field for incision planning. In the first stage of the surgery, the pedicles are then cannulated with navigated instruments in preparation for screw placement. Pedicle screws are then placed using robotic guidance to ensure accuracy with a single pass.
SPEAKER: The robotic navigation platform is then used to guide tubular retractor placement to assist with the next stage of the surgery. Microscopic decompression of the nerve roots and facetectomies utilizing robotic navigation is completed bilaterally. Reduction is then achieved by tightening facet screws sequentially from S2-A-I to L4 on the left-sided rod while expanding the interbody trial in tandem. The interbody cage is then placed using robotic navigation.
SPEAKER: Final X-rays are completed to show good placement of all hardware and reduction of the spondylolisthesis. Noted at L4 are the cement augmented pedicle screws to prevent pullout. The incision sizes ranged from 0.5 to 7 centimeters in length. Postoperative CT and MRI shows complete reduction of the spondylolisthesis at L5–S1, with good placement of the hardware and cement, as well as significant improvement in lateral recess and foraminal stenosis.
SPEAKER: The patient was able to continue with her immunotherapy and hormonal therapy in the perioperative period. Her numerical rating score for pain decreased from 10 to 4 immediately after surgery. She was able to ambulate independently within 12 hours of surgery and was discharged from the hospital on postoperative day 2.
SPEAKER: At 2 months after surgery, her pain score was decreased to 2 from her oncologic pain. Her preoperative radiculopathy has resolved.
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