Navigated Robotic Guidance for Minimally Invasive Bertolotti Resection: Technical Feasibility and Workflow Evaluation
Year: 2026
Type: preprint
Abstract: Bertolotti syndrome is characterized by symptomatic lumbosacral transitional vertebral anatomy in which an enlarged transverse process articulates or fuses with the sacrum or ilium. Diagnosis can be difficult because transitional anatomy is common, symptoms may overlap with other spinal disorders, and the pain generator may arise from the pseudoarticulation, adjacent disc or facet, instability, or nerve compression. When targeted nonoperative treatment fails, surgical options include resection, nerve decompression, or fusion depending on anatomy and the dominant pain mechanism. Published evidence supports image guidance for localization and confirmation of resection and describes early robotic assistance for trajectory and incision planning; however, evidence specific to robotic Bertolotti resection remains limited. This article evaluates the feasibility of a preoperatively planned, navigated robotic workflow for minimally invasive Bertolotti resection. A framework is presented for preoperative computed-tomography planning, convergent access through a minimally invasive incision, trajectory-controlled drilling of bone-cut trajectories across the transverse processes and pseudoarticulations, navigated osteotomy, fragment removal and verification of complete decompression or resection. Feasibility was assessed by completion of planned robotic and navigated steps, intraoperative confirmation of registration and resection, and review of technical, perioperative, and imaging outcomes. These concepts may improve reproducibility and reduce challenges related to limited visualization and complex three-dimensional anatomy, but do not prove superior outcomes. This paper outlines a novel technique; however, further comparative studies using standardized measures of pain, disability, operative time, blood loss, radiation exposure, navigation accuracy, resection quality, and reoperation rate are needed before the clinical value of robotic guidance is established.
Source: Research Square
Authors: Christopher R. Good, Zachary R. Good
Institution: Virginia Spine Institute
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225184976