Longitudinal Effect of Robotic Instrumentation in Minimally Invasive Spine Surgery: A 5 Year Outcomes Study

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

PD

Pooja R. Dave

Miami, Florida, United States
JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
PT

Peter S. Tretiakov, BS

United States
SV

Shaleen Vira, MD

Assistant Professor, Orthopaedic Surgery & Neurosurgery
UT Southwestern Medical Center
Dallas, Texas, United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Disclosure(s):

Peter G. Passias, MD: No relevant disclosure to display

Background: Robotics use in spine surgery has been increasing in recent years. Although perioperative and short term outcomes have been well reported on for robotic surgery, with favorable outcomes. It is unclear whether longer term outcomes are sustained using robotics relative to traditional approaches.

Purpose: To determine if longer term clinical outcomes with the use of robotics in spine surgery is safe and efficacious. Secondary comparison of robotic surgery to non-robotic cases.

Methods: Patients undergoing minimally invasive spine surgery with 3 and 5 year data included. Patients were stratified into robotic (R) and nonrobotic (NR) cohorts. Descriptive analyses identified differences in demographics and surgical details. Sustained Clinical Benefit Good Outcome (GO) defined as meeting either: 1) SCB for ODI by 2Y (change greater than 18.8), or 2) ODI < 15 and SRS-Total >4.5 by 2Y. ANCOVA and logistic regressions were utilized to assess differences in outcomes, including complications, reoperations, and HQRLs, while accounting for covariates as appropriate. Univariate analysis was used to assess baseline, surgical, and radiographic characteristics of those treated robotically compared to nonrobotic. Multivariate analyses controlling for age and baseline deformity assessed differences in 5 year outcomes between groups.

Results: 394 patients were included (Age: 56.1±11.4 years, 48% female, BMI: 31.6±6.72 kg/m2, CCI: 2.68±1.41), with 138 of those who underwent robotic surgery (35%). R group had higher CCI compared to non-robotics (2.6±1.5 vs 1.9±1.5) and lower number of levels fused (2.9 vs 4.2, both p<.001). In baseline deformity, robotic patients had similar radiographics in: LL (49±14), SS (35±8), PI-LL (4.9±10). However, PT (22.6 vs 19.2, p=.044) was higher in R group. By 3 years, radiographic deformity were similar (all p>.05). From 3 to 5 years, R group had 36% lower chances of overall complications compared to NR (OR: .64 [1.73, 2.28] p=.012).They also had lower odds of reoperations (OR: .68 [.23, 1.55] p <.005) and readmission (OR:.75 [1.53, 1.98], p=.035). Rate of achieving Sustained Clinical Benefit at 5 years was greater in R group (8.9% vs 7.1%, p= .076). Patients undergoing robotics had a lower ODI (34 vs 42), lower NRS Back pain (3.9 vs 5.2), and lower NRS Leg pain (3.14 vs 4.2). By 5 years, R had a complication rate of 70.7%. 26(26.3%) had a major complication and 25 (25.3%) underwent a reoperation. 38 (38.4%) developed PJK and 4 (4.0%) developed PJF. In a multivariate analysis, patients with robotics were less likely to undergo a reoperation before 2 year than NR (OR 5.2 [1.2, 2.3], p=.022). This difference subsided beyond 2 year.

Conclusions: Robotic minimally invasive spine surgery has the potential to reduce long term complications. Our study sought to quantify complication and patient-report outcome differences by 5 years postoperatively after robotic spine surgery. Increase technological assistance through robotics reduces odds of reoperations and has overall positive effect on patient outcomes, enhancing recovery process and reducing long term risks.