Circumferential fusion employs both anterior and posterior approaches to provide comprehensive decompression and 360-degree stability for complex thoracic and thoracolumbar pathologies. This approach is particularly valuable for severe traumatic injuries, aggressive tumours, extensive infections, or significant deformities requiring substantial reconstruction. By addressing both anterior and posterior columns, circumferential fusion provides maximal stability while allowing for complete neural decompression and structural reconstruction.
The robotic approach to circumferential fusion typically begins with the anterior procedure, which may be performed through thoracotomy, thoracoscopy, or retroperitoneal approaches. The robotic system guides vertebrectomy when needed and the placement of an anterior structural support, such as an expandable cage. After completion of the anterior stage, the patient is repositioned for the posterior approach. Using updated imaging, the robotic system creates a new 3D map incorporating the anterior reconstruction.
The robotic arm then guides the placement of pedicle screws with exceptional precision, which is particularly valuable after substantial anterior column reconstruction has altered normal anatomical relationships. This coordinated circumferential approach maximises stability and reconstructive potential for the most challenging thoracic and thoracolumbar pathologies, potentially improving outcomes in cases that would be inadequately addressed by a single approach.
