Robot-Assisted versus Freehand Instrumentation in Short-Segment Lumbar Fusion: Experience with Real-Time, Image-Guided Spinal Robot. World neurosurgery Jiang, B., Pennington, Z., Azad, T., Liu, A., Ahmed, A. K., Zygourakis, C. C., Westbroek, E. M., Zhu, A., Cottrill, E., Theodore, N. 2020

Abstract

Rising patient demand for minimally invasive surgery and increased payer emphasis on quality-based payment schema have created a need for technologies that provide consistent, high-quality outcomes for patients undergoing spine surgery. Robotic assistance is one such technology. Here we report our early experience with a novel real-time, image-guided robot system for use in short-segment lumbar fusion in patients diagnosed with degenerative disease.A consecutive series of patients undergoing robot-assisted 1- or 2-level lumbar fusion procedures were compared to matched controls who underwent free-hand surgery. Screw accuracy, intraoperative outcomes, and 30-day outcomes were compared.We identified 56 patients who underwent 1- or 2-level lumbar fusion during the study period: 28 who underwent robot-assisted procedures and 28 matched controls who underwent freehand instrumentation placement. No significant differences were found between the robot-assisted surgery cohort and the freehand surgery cohort with respect to matched variables. Patients who underwent robot-assisted surgery had less intraoperative blood loss (266.1±236.8 vs. 598.8±360.2mL; p < 0.001) and shorter hospitalizations (3.5±1.8 vs. 4.5±2.0d; p = 0.01). No differences were noted in complication rates, 30-day outcomes or screw accuracy. Profiling of our initial series revealed an average reduction in operation duration of 4.6 minutes with each additional case.Patients undergoing robot-assisted fusion experienced less intraoperative blood loss and shorter hospitalizations. The results of this initial experience suggest that an image-guided robotic system may provide similar short-term outcomes compared with freehand instrumentation placement.

View details for DOI 10.1016/j.wneu.2020.01.119

View details for PubMedID 32001398