Robot-Guided Full-Endoscopic Resection of an L5 Osteoid Osteoma: Precise Targeting and Preservation of Spinal Structures
🔎 Dr. Jiancheng Zeng and the orthopaedic team at West China Hospital, Sichuan University, recently reported robot-guided full-endoscopic resection of an L5 osteoid osteoma. The case illustrates how navigation and endoscopy can complement each other in the treatment of focal spinal bone lesions.
📋 The patient was a 17-year-old adolescent with persistent low back pain and radiating pain in the left lower limb. Imaging revealed a lesion in the left posterior elements of L5, surrounded by sclerotic bone and located close to the dural sac and neural structures. The technical challenge was to accurately localize and completely remove the nidus while limiting the removal of normal bone.
Three aspects of the surgical workflow are particularly relevant:
🎯 1. Three-dimensional trajectory planning and precise targeting
Robotic navigation supported the planning of the approach and working corridor to this deep-seated lesion. Its potential value extends beyond reaching the target: it may also help limit unnecessary bony exposure when locating the nidus.
🔬 2. Resection under direct endoscopic visualization
Navigation supported access, while endoscopy provided a magnified local view. These technologies address complementary tasks: reaching the lesion and treating it. Decisions regarding the extent of resection and protection of neural structures still depend on the surgeon’s interpretation of imaging, anatomy, and intraoperative findings.
🦴 3. Preservation of stabilizing structures and the motion segment
The reported procedure used an approximately 7-mm incision and a 7-mm bony window in the left posterior elements of L5, without instrumented fusion. For an adolescent patient, preserving normal bone and the spinal motion segment is an important objective of this minimally invasive strategy.
📊 Reported early outcomes included approximately 5 mL of intraoperative blood loss, ambulation and oral intake two hours after surgery, and discharge at 16 hours. Low back pain, radiating leg pain, and pain-related scoliosis improved substantially.
📌 Endoscopic resection and navigation-assisted resection of spinal osteoid osteoma have previously been described in the literature. The value of this case lies in the integration of robotic trajectory planning with direct endoscopic visualization, together with an emphasis on structural preservation. Long-term pain control, local recurrence, and segmental stability require further follow-up.
