Robotic Assisted Minimally Invasive Transfacet Lumbar Interbody Fusion (El-Naggar Zlif operation)

Introduction: Introduction
A novel approach of a robotic assisted minimally invasive transfacet lumbar interbody fusion
surgery (El-Naggar ZLIF Operation). A corridor is through midfacet of the zygapophyseal joint (
Z-Joint) to enter the disk space without exposure of any of the neural elements. outcome of
110 patients with this technique is included.

Methods: Methods
A retrospective study of 110 patients underwent ZLIF operation. The preoperative planning
was based on MRI or a CT myelogram in addition to a pre-operative lumbar CT scan in the
prone position. We utilized the Mazor – X system for placement of the Interbody device as well
as the percutaneous pedicle screws and rods. Bony facet fusion is also performed. Other
modalities of pre-operative planning such as the use of the O arm or exclusive was excluded.
Those patients underwent single or two level fusion surgery from L3 through S1 starting in
March 2020 up till now. we monitored the operating room times, blood loss, hospital stay, use
of narcotics, and return to work after surgery, pain and all ADL scores before and after surgery.

Results:

Results:
95% of the patients were discharged within 24 hours, of whom 70% were discharged from
recovery room a few hours after surgery. The incidence of postoperative infection, spinal fluid
leakage and neurological deficit was 0%. Temporary paresthesias occurred in 2.2% of our earlier
patients. Pain relief was in the order of 75% within three months after surgery. 95% of patient’s
had CT evidence of ongoing fusion three months after surgery. Long term data and prospective
studies will be reported.

Conclusion : We believe this is an excellent direct approach into the disc space unlike any other where nerve
roots or dura or viscera or vascular structures have to be dealt with.