90-Day Complication and Revision Surgery Rates Using Navigated Robotics in Thoracolumbar Spine Surgery

Friday, June 2, 2023

3:23 PM – 3:27 PM

Location: Salon 9

Co-Author(s)

LO

Lindsay Orosz, MS, PA-C

Director of Research
The National Spine Health Foundation
Reston, Virginia, United States
NL

Nathan J. Lee, MD

Orthopedic Surgery Resident
Columbia University Medical Center
New York, NY, United States
TY

Tarek Yamout, MD

United States
JG

Jeffrey L. Gum, MD

Adult and Pediatric Spine Surgeon
Norton Leatherman Spine
Louisville, Kentucky, United States
RL

Ronald Lehman, MD

United States
GP

Gregory Poulter, MD

United States
CH

Colin Haines, MD

Spine Surgeon, Director of Research
Virginia Spine Institute
Reston, Virginia, United States
EJ

Ehsan Jazini, MD

Spine Surgeon
Virginia Spine Institute
Reston, Virginia, United States
CG

Christopher R. Good, MD

Spine Surgeon, President
Virginia Spine Institute
Reston, Virginia, United States

Submitter(s)

LO

Lindsay Orosz, MS, PA-C

Director of Research
The National Spine Health Foundation
Reston, Virginia, United States

Presenting Author (Person doing the Podium Present(s)

JL

Joseph Lombardi, MD

United States

Disclosure(s):

Lindsay Orosz, MS, PA-C: No financial relationships to disclose

Introduction: Individually, robotic guidance and real-time 3-Dimensional navigation assistance have both been shown to improve surgical outcomes and accuracy in spine surgery. The more recent pairing of these advanced technologies may further improve outcomes; however, data is needed to support this expectation.

Objectives: This large, prospective, multicenter cohort study focuses on outcomes associated with thoracolumbar spine surgery using an integrated robotic and navigation surgical platform. This study reports on 90-day complications and revision surgeries using one bone-mounted robotic with navigation confirmation platform.

Methods: Adults undergoing navigated robotic thoracolumbar surgery from 2020-2022 were prospectively enrolled by 6 surgeons at 4 distinct centers across 3 US regions. Each surgeon’s experience using navigation and robotics was advanced. Medical, surgical, and robot related complications and revision surgeries were collected to 90 days. Demographics and outcomes were analyzed for means and frequencies.

Results: Of 411 surgeries, 3,469 screws were implanted (82.9% pedicle, 17.1% cortical). The majority (93.4%) underwent interbody fusion, 56.2% staged and 43.8% single day (52.8% posterior, 40.6% AP flip, 6.7% AP single position). Mean levels fused were 4.4 ± 3.7 and revision cases were 6.3%. Most frequent diagnoses were spondylolisthesis (37.2%) and spinal deformity (22.1%). Average ASA score was 2.3 ± 0.6, CCI was 0.49 ± 1.0, BMI was 29.6 ± 5.7 kg/m², and 11.9% were nicotine users. Intraoperative adverse events occurred in 4.1%, 0.5% robot related (1 durotomy, 1 implant-related). The frequency of patients with at least one postoperative complication was 21.7%. Unique complications were: 6.6% surgical (19.4% before discharge, 38.7% within 2 weeks, 41.9% by 90 days), 18.2% medical (36.1% before discharge, 43.3% within 2 weeks, and 20.6% by 90 days), and 0% robot related. Revision surgery rate at 90-days was 1.5%, none being robot related.

Conclusion: This study demonstrates that experienced users of an integrated navigation and robotic spine platform achieve low complication and revision surgery rates during thoracolumbar spine surgery. We found 4.1% intraoperative complications (0.5% robot related), 21.7% with any postoperative complication (6.6% unique surgical, 0% robot related), and 1.5% revision surgeries (0% robot related).