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