Daigle A, Quinones C, Tran H, Whipple G, Kumbhare D, Allampalli V, Guthikonda B, Hoang S. Awake robotic lumbar decompression and fusion: A case report. World J Clin Cases 2026; 14(24): 120680 [DOI: 10.12998/wjcc.120680]
Corresponding Author of This Article
Stanley Hoang, MD, Assistant Professor, Department of Neurosurgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, United States. stanley.hoang@lsuhs.edu
Research Domain of This Article
Neurosciences
Article-Type of This Article
case-report
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World J Clin Cases. Aug 26, 2026; 14(24): 120680 Published online Aug 26, 2026. doi: 10.12998/wjcc.120680
Awake robotic lumbar decompression and fusion: A case report
Andrew Daigle, Christian Quinones, Huy Tran, Garrett Whipple, Deepak Kumbhare, Varsha Allampalli, Bharat Guthikonda, Stanley Hoang
Andrew Daigle, Christian Quinones, Huy Tran, Garrett Whipple, Deepak Kumbhare, Bharat Guthikonda, Stanley Hoang, Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
Varsha Allampalli, Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
Author contributions: Daigle A, Quinones C, Whipple G, and Hoang S designed the case report; Quinones C, Whipple G, Kumbhare D, and Allampalli V acquired and analyzed the clinical data; Daigle A and Tran H provided technical oversight, editing of the manuscript and figure curation; Hoang S and Guthikonda B performed the surgical procedure; Quinones C and Whipple G drafted the manuscript; Kumbhare D, Allampalli V, Guthikonda B, and Hoang S critically revised the manuscript for important intellectual content; and all authors have read and approved the final version of the manuscript.
AI contribution statement: AI tools were used solely for limited linguistic refinement and formatting assistance during manuscript preparation. All AI-generated edits were manually reviewed and revised by the authors. No AI tool was involved in the conceptualization, data analysis, clinical interpretation, or scientific content of this manuscript, and the authors take full responsibility for the integrity and accuracy of the work.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Stanley Hoang, MD, Assistant Professor, Department of Neurosurgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, United States. stanley.hoang@lsuhs.edu
Received: March 5, 2026 Revised: May 29, 2026 Accepted: August 10, 2026 Published online: August 26, 2026 Processing time: 167 Days and 19.9 Hours
Abstract
BACKGROUND
Lumbar degenerative disease affects nearly one-third of adults over 65 years old in the United States, a population expected to reach 89 million by 2050. Advances in minimally invasive spine surgery aim to address this growing demand by reducing blood loss, recovery time, and hospitalization. Robotic spine surgery improves hardware placement accuracy and reduces radiation exposure, while awake spine surgery performed under spinal anesthesia minimizes risks associated with general anesthesia and postoperative opioid use. However, reports describing the combined application of these techniques remain limited.
CASE SUMMARY
A 57-year-old male with hypertension presented with progressive neurogenic claudication and mechanical back pain refractory to conservative management. Magnetic resonance imaging demonstrated L4-L5 disc bulge with ligamentum flavum hypertrophy and central canal stenosis. After discussing operative options, the patient elected to undergo awake robotic-assisted L4-L5 decompression and fusion under spinal anesthesia. Preoperative thin-cut computed tomography was used for robotic trajectory planning. Intraoperatively, spinal anesthesia achieved adequate motor and sensory blockade, allowing prone positioning and robotic placement of cortical screws followed by decompression and fusion. The procedure was completed without complications, and postoperative imaging confirmed appropriate hardware placement. The patient recovered uneventfully and was discharged on postoperative day one.
CONCLUSION
Awake robotic lumbar decompression and fusion under spinal anesthesia is feasible and was completed without conversion to general anesthesia, supporting the combination of robotic precision with the recovery advantages of spinal anesthesia.
Core Tip: Minimally invasive spine surgery (MISS) provides several advantages, including reduced intraoperative blood loss, shorter recovery times, and decreased length of hospitalization. Cortical bone trajectory screws further enhance MISS by allowing a medial-to-lateral trajectory that reduces the need for extensive retraction, permits smaller incisions, and provides robust biomechanical fixation. Robotic spine surgery complements these techniques by offering enhanced intraoperative imaging and improved precision in hardware placement. Awake spine surgery performed under spinal anesthesia can be combined with robotic techniques to further shorten recovery and reduce postoperative pain.
