Perioperative Comparison of Robotic-Assisted versus Fluoroscopy-Guided Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF).

ABSTRACT 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 when compared to open surgery. The aim of this study was to compare the perioperative outcomes between robot-assisted (RA) and fluoroscopy-guided (FG) minimally-invasive (MIS) transforaminal lumbar interbody fusion (TLIF), performed by a single surgeon. Methods This retrospective cohort study analyzed all patients with lumbar degenerative disease that underwent MIS-TLIF by a single surgeon during the period from July 2017 to March 2020. One group was comprised of patients that underwent FG MIS-TLIF, while the other cohort underwent RA MIS-TLIF. Results 101 patients were included in the study, 52 underwent a RA MIS-TLIF, 49 a FG MIS-TLIF. We found no statistically significant difference in operative time: 241±69.3 minutes for the RA technique, 246.2±56.3 minutes for the FG (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. Our RA radiation exposure data was compared with similar data for FG MIS-TLIF from Bindal et al. (59.5±60.4 mGy), and found to be significantly lower (p=0.035). Postoperative complications and rates of surgical revision were comparable. Conclusions Our study demonstrated that robot-assisted MIS-TLIF has comparable perioperative outcomes to fluoroscopy-guided MIS-TLIF. A reduced radiation dose to the patient was observed when compared to fluoroscopy-guided MIS-TLIF. No differences were noted between the RA and FG cohorts in operative times, complication rates, revision rates and length of stay.