MedStar Orthopaedic Institute Performs Region’s First Lateral Lumbar Interbody Fusion

Robotic Navigation Guides Minimally Invasive Procedure Through Side Incision

April 8, 2021

BALTIMORE —A team of spine experts led by veteran surgeons Paul Asdourian, MD and Paul McAfee, MD of MedStar Orthopaedic Institute, became the first in the mid-Atlantic region to use robotic GPS navigation to perform a lateral lumbar interbody fusion (LLIF) through a tiny incision in the patient’s side.

They first applied the technology March 23 at MedStar Union Memorial Hospital on a lumbar fusion case to replace two discs and align the spine of a 55-year old female. The patient had been suffering from painful, degenerative disc disease and arthritis in her lower back that prevented her from being able to stand up straight.

With a standard approach to fusion surgery, the spine is accessed through the abdomen, or posteriorly, through a large incision in the back.

“Going in through the patient’s side means you don’t have to cut through as many muscles or surrounding tissue, there’s significantly less blood loss and the incision is smaller,” said Dr. McAfee, a pioneer of the LLIF technique.

Dr. Asdourian and Dr. McAfee used ExcelsiusGPS® technology to navigate surgical instruments and hardware through a small incision at the waist, and with precision, safely and accurately removed the damaged discs, inserted spacer bone grafts to separate vertebrae and lifted pressure off pinched nerves. The robotics ensured visualization of the patient’s anatomy during the procedure, streamlined surgical workflow and reduced x-ray radiation exposure to the team.

“We can be more precise doing the LLIF approach using the robotic navigation,” Dr. McAfee said. “If you’re going to put something inside the human body, you have to figure out where to start and you have to figure out the trajectory to get to where you’re going. You spend as much time planning out the surgery as you do performing it but you go in knowing exactly which instruments you’re using, the size of the implant, and you’re not doing a  lot of improvisation at the time of surgery.”

“It's a more effective approach in trying to change the alignment of the spine,” added Dr. Asdourian, “so that we recreated the normal curvature of her back and she would be able to stand up straight. Having the robot to navigate the placement of your instrumentation so that you know that your instruments are in a perfect position, was hugely successful.”

The bone graft they implanted will bridge the two bones to promote fusion. Within three to six months, new bone cells will grow around the graft and fuse the two vertebrae, forming one solid piece of bone.

“Without the robotic navigation, we would have done this from a posterior approach,” Dr. Asdourian explained. “But to do so, you have to be more aggressive in removing bone with greater blood loss and it's a harder operation for patients to recover from. This case didn’t require a blood transfusion, and the patient is able to stand straight up. The case went perfectly and she’s doing great.”

Patients may be a candidate for LLIF if they’ve been diagnosed with:

  • degenerative disc disease
  • low-grade spondylolisthesis
  • mild to moderate scoliosis
  • symptoms that do not improved with physical therapy or medication

Patients may not be a candidate for the procedure if they have any of the following:

  • damaged disc at L5-S1, because the hip bone blocks access
  • severe spondylolisthesis or scoliosis
  • other problems that would prevent bone fusion
  • prior abdominal surgery near the kidneys

For more information on robotic navigation lateral lumbar interbody fusion, or to schedule an appointment, call: 410-554-2175.

About MedStar Health
At MedStar Health, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. Our 30,000 associates and 4,700 affiliated physicians are committed to living this promise through our core SPIRIT values—Service, Patient first, Integrity, Respect, Innovation, and Teamwork—across our more than 300 locations including 10 hospitals, ambulatory, and urgent care centers. As the medical education and clinical partner of Georgetown University, MedStar Health is training future physician leaders to care for the whole person and is advancing care through the MedStar Health Research Institute. From our telemedicine and urgent care services to the region’s largest home health agency, we’re committed to providing high-quality health care that’s also easy and convenient for our patients. At MedStar Health—It’s how we treat people. Learn more at

Media Contact

Debra Schindler
Regional Director, Media & Public Relations, MedStar Health Baltimore
Office: 410-554-2496
Cell: 410-274-1260
[email protected]

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