The Early Clinical and Radiographic Outcomes of Robotic Assisted Midline Lumbar Interbody Fusion (MIDLIF): A Case Series

Introduction: Midline lumbar interbody fusion (MIDLIF) is a less invasive alternative to posterior fusion, requiring less tissue retraction due to cortical screw placement. Robotic assistance improves screw placement accuracy, easing the process. This study evaluates the clinical and radiographic outcomes of robotic-assisted MIDLIF procedures.

Methods: A retrospective case series was performed of patients who underwent MIDLIF procedures for the treatment of degenerative spinal diseases, with a minimum of three months postoperative follow-up. Demographic, surgical, patient reported outcomes (PROs), and radiographic data were collected. In total, 42 patients were included, with an average age of 53.6 years and BMI of 28 kg/m2.

Results: Surgical data showed mean total operative time was 98.8 min, mean blood loss was 17.1 mL with no intraoperative complications. VAS back pain improved from 7.5 ± 0.7 preoperatively to 3.0 ± 1.0 at 3-month postoperative, while ODI improved from 58.7 ± 7.2 to 26.3 ± 10.3 at the same time point (all, p < 0.05). Radiographic data showed that using robotic assistance for planning and placing cortical screws yielded high accuracy, as evidenced by a mean tip deviation of 1.2 ± 0.6 mm, mean tail deviation of 1.1 ± 0.4 mm, and a mean angular offset of 1.4 ± 0.7°. Two (4.8%) patients had postoperative complications at 3-month follow-up, including a wound infection and one report of wound dehiscence.

Conclusion : This study showed that MIDLIF is an efficient, reproducible procedure with a low complication rate and significant early PRO improvements. Robotic assistance for placing cortical screws was highly accurate, adding value to MIDLIF procedures and potentially serving as an alternative to traditional posterior fusion.