Enabling Technology with Minimally Invasive Strategies: Robot-Assisted Cortical Bone Trajectory Screw Fixation in Lateral Transpsoas Interbody Fusion

OBJECTIVE: Robot-assisted cortical bone trajectory (CBT) screw placement is safer than the traditional fluoroscopy-assisted approach. This technical note reports a novel technique of robot-assisted CBT screw placement using a subfascial transmuscular approach. METHODS: This technique involves two stages: first, the positioning of a lumbar interbody cage through a lateral transpsoas approach, and then, the robot-assisted placement of CBT screws. The second step is performed with the patient in prone position with navigation frames (ICT, DRB, and surveillance-marker) registered to the robotic system. A threedimensional fluoroscopic scan is used to plan the screw trajectory, diameter, and length. The screws are placed with the support of a robotic arm. RESULTS: The technique allows for accurate and precise placement of CBT screws with minimal soft tissue dissection. Compared to traditional methods, the single-lateral position approach reduces intraoperative time and minimizes postoperative pain and recovery time. The percutaneous transmuscular approach avoids the need for fascial dissection, decreasing the risk of complications such as seroma or hematoma formation. CONCLUSIONS: To our knowledge, this is the first reported technical note about robot-assisted transmuscular CBT screw placement for posterior fixation in LLIF. The proposed surgical technique aims to combine the advantages of CBT screws and the use of innovative robot-assisted technology.