Clinical Case Study / Complex Spine

Targeted Robotic Realignment for Degenerative Scoliosis

A woman in her 70s with severe back pain, difficulty walking and a visible lean underwent robotic-assisted single-position anterior-posterior lumbar fusion focused on the two levels driving her deformity — improving alignment without a larger spinal realignment operation.

DiagnosisDegenerative scoliosis with focal disc collapse
LevelsL2–3 and L3–4
ProcedureRobotic single-position lumbar fusion
OutcomeImproved posture with little to no pain
The Clinical Challenge

A broad deformity driven by two focal levels

The patient presented with severe mid- to low-back pain, difficulty walking and a visible lean. Standing scoliosis X-rays showed a broader spinal deformity, but the most important structural problem was concentrated at L2–3 and L3–4, where asymmetric degeneration had caused the discs to collapse more on the right side.

The surgical question was not simply how to straighten the entire spine. It was whether the levels driving the painful imbalance could be corrected with a more focused operation.

Preoperative Imaging

Identifying the levels driving the imbalance

The standing X-ray demonstrates the patient’s degenerative scoliosis and visible lean. Review of the deformity localized the most significant asymmetric disc collapse to L2–3 and L3–4, allowing the plan to focus on those levels rather than a more extensive reconstruction.

Preoperative standing X-ray showing degenerative scoliosis and spinal imbalance before targeted lumbar fusion
Before Surgery

Degenerative Scoliosis With Focal Collapse

Standing imaging shows the broader deformity and lean before targeted correction of L2–3 and L3–4.

The Treatment Decision

Why target two levels instead of performing a larger reconstruction?

In consultation with the patient, Kimberly B. Ashayeri, MD, determined that the best path to improved comfort and posture was to address the asymmetric discs responsible for the focal bend rather than perform a major spinal realignment operation.

The plan called for fusion at L2–3 and L3–4 using a single-position technique that allowed the lateral and posterior portions of the operation to be completed without changing the patient’s side-lying position.

Target the driver of the deformityFocus on the two asymmetrically collapsed levels contributing to the patient’s lean.
Avoid unnecessary surgical extentSeek meaningful realignment without extending fusion across the broader curve.
Use one operative positionComplete anterior correction and posterior fixation without repositioning the patient.
The Surgical Strategy

Anterior correction and posterior fixation — without repositioning

Dr. Ashayeri performed robot-assisted single-position lumbar surgery using the ExcelsiusGPS® robotic navigation platform. Integrated imaging was used to create a detailed surgical roadmap for instrumentation and hardware placement.

1. Plan with robotic navigation

Integrated imaging and navigation supported preoperative mapping and implant trajectory planning.

2. Restore disc height and alignment

Through a lateral trajectory, the degenerated discs at L2–3 and L3–4 were removed and replaced with spacers to improve alignment.

3. Add posterior fixation in the same position

Without turning the patient, the rigid robotic arm guided posterior pedicle screw placement to complete the L2–3 and L3–4 fusion.

4. Limit the surgical footprint

The minimally invasive approach did not require the surgical drains typical of lumbar fusion.

The Outcome
Walking immediately after surgery. Home two days later.

The patient was able to walk across the room immediately after surgery and was discharged two days after the operation.

At follow-up, she stood visibly straighter with little to no pain. Imaging showed improvement in the focal bend, and she continued her recovery with physical therapy.

Postoperative Alignment

Improved alignment after targeted fusion

Compared with the preoperative standing X-ray above, postoperative imaging demonstrates improved alignment across the treated L2–3 and L3–4 levels following targeted fusion.

Postoperative X-ray showing improved alignment after L2-3 and L3-4 lumbar fusion
After Surgery

Improved Alignment

Postoperative imaging shows correction across the treated levels with posterior fixation at L2–3 and L3–4.

Why This Case Matters

Sometimes the right correction is not the biggest correction

Degenerative scoliosis can involve a broad spinal curve, but the entire deformity does not always need to be reconstructed. In this case, the treatment strategy focused on the two levels most responsible for the patient’s painful imbalance.

Targeted realignmentCorrect the focal structural problem rather than defaulting to a larger reconstruction.
Single-position efficiencyPerform lateral interbody work and posterior fixation without repositioning.
Robotic precisionUse image-guided planning and robotic navigation to support instrumentation placement.
Kimberly B. Ashayeri, MD, complex and robotic spine surgeon at Atlantic Brain and Spine
Complex & Robotic Spine Surgery

Kimberly B. Ashayeri, MD

Dr. Kimberly Ashayeri is a fellowship-trained neurosurgeon specializing in complex, minimally invasive and robotic spine surgery. Her work includes degenerative spinal disorders, scoliosis, complex reconstruction and motion-preserving approaches.

View Dr. Ashayeri’s Bio →
Complex Spine & Scoliosis

The right operation starts with the right surgical plan.

For patients with degenerative scoliosis or complex lumbar disease, the goal is not simply to perform the largest correction possible. Our spine team evaluates the anatomy, symptoms and treatment options to determine the approach that fits the individual patient.

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