Robot-Assisted versus Freehand Instrumentation in Short-Segment Lumbar Fusion: Experience with Real-Time Image-Guided Spinal Robot

Bowen Jiang, Zach Pennington, Tej Azad, Ann Liu, A. Karim Ahmed, Corinna C. Zygourakis, Erick M. Westbroek, Alex Zhu, Ethan Cottrill, Nicholas Theodore

Research output: Contribution to journalArticle

Abstract

Objective: Increasing 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. 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. Methods: A consecutive series of patients undergoing robot-assisted 1-level or 2-level lumbar fusion procedures were compared with matched controls who underwent freehand surgery. Screw accuracy, intraoperative outcomes, and 30-day outcomes were compared. Results: We identified 56 patients who underwent 1-level 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 mL vs. 598.8 ± 360.2 mL; P < 0.001) and shorter hospitalizations (3.5 ± 1.8 days vs. 4.5 ± 2.0 days; P = 0.01). No differences were noted in complication rates, 30-day outcomes, or screw accuracy. Profiling of our initial series showed an average reduction in operation duration of 4.6 minutes with each additional case. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)e635-e645
JournalWorld neurosurgery
Volume136
DOIs
StatePublished - Apr 2020

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Keywords

  • Image-guided robotic surgery
  • Robot-assisted surgery
  • Robotic spine surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Jiang, B., Pennington, Z., Azad, T., Liu, A., Ahmed, A. K., Zygourakis, C. C., Westbroek, E. M., Zhu, A., Cottrill, E., & Theodore, N. (2020). Robot-Assisted versus Freehand Instrumentation in Short-Segment Lumbar Fusion: Experience with Real-Time Image-Guided Spinal Robot. World neurosurgery, 136, e635-e645. https://doi.org/10.1016/j.wneu.2020.01.119