Perioperative Comparison of Robotic-Assisted Versus Fluoroscopically Guided Minimally Invasive Transforaminal Lumbar Interbody Fusion

OBJECTIVE: Robotic surgical systems have been developed to improve spine surgery accuracy. Studies have found significant reductions in screw revision rates and radiation exposure with robotic assistance compared with open surgery. The aim of the present study was to compare the perioperative outcomes between robot-assisted (RA) and fluoroscopically guided (FG) minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) performed by a single surgeon. METHODS: The present retrospective cohort study analyzed all patients with lumbar degenerative disease who had undergone MI-TLIF by a single surgeon from July 2017 to March 2020. One group had undergone FG MI-TLIF and one group had undergone RA MI-TLIF. RESULTS: Of the 101 patients included in the present study, 52 had undergone RA MI-TLIF and 49, FG MI-TLIF. We found no statistically significant differences in the operative time (RA, 241 +/- 69.3 minutes; FG, 246.2 +/- 56.3 minutes; P = 0.681). The mean radiation time for the RA group was 32.8 +/- 28.8 seconds, and the mean fluoroscopy dose was 31.5 +/- 30 mGy. The RA radiation exposure data were compared with similar data for the FG MI-TLIF group in a previous study (59.5 +/- 60.4 mGy), with our patients' radiation exposure significantly lower (P = 0.035). The post-operative complications and rates of surgical revision were comparable. CONCLUSIONS: Our results have demonstrated that RA MI-TLIF provides perioperative outcomes comparable to those with FG MI-TLIF. A reduced radiation dose to the patient was observed with RA compared with FG MI-TLIF. No differences were noted between the RA and FG cohorts in operative times, complication rates, revision rates, or length of stay.

Automated summary

The study compared perioperative outcomes between robot-assisted (RA) and fluoroscopically guided (FG) minimally invasive transforaminal lumbar interbody fusion (TLIF) performed by a single surgeon. Results showed that RA group had lower radiation exposure compared to FG group. There were no significant differences in operative time, post-operative complications, surgical revision rates, or length of stay between the RA and FG cohorts.