Clinical Outcomes of Robotic Versus Freehand Pedicle Screw Placement After One-to Three-Level Lumbar Fusion

Abstract

Study Design Retrospective cohort study Objectives The purpose of this study is to compare patient-reported outcome measures (PROMs) for patients undergoing one-to three-level lumbar fusion using robotically assisted vs freehand pedicle screw placement. Methods Patients who underwent either robotically assisted or freehand pedicle screw placement for one-to three-level lumbar fusion surgery from January 1, 2014 to August 31, 2020 at a single academic institution were identified. Propensity score matching was performed based on demographic variables. Clinical and surgical outcomes were compared between groups. Recovery Ratios (RR) and the proportion of patients achieving the minimally clinically important difference (%MCID) were calculated for Oswestry Disability Index, PCS-12, MCS-12, VAS Back, and VAS Leg at 1 year. Surgical outcomes included complication and revision rates. Results A total of 262 patients were included in the study (85 robotic and 177 freehand). No significant differences were found in ΔPROM scores, RR, or MCID between patients who underwent robotically assisted vs freehand screw placement. The rates of revision (1.70% freehand vs 1.18% robotic, P = 1.000) and complications (.57% freehand vs 1.18% robotic, P = .546) were not found to be statically different between the 2 groups. Controlling for demographic factors, procedure type (robotic vs freehand) did not emerge as a significant predictor of ΔPROM scores on multivariate linear regression analysis. Conclusions Robotically assisted pedicle screw placement did not result in significantly improved clinical or surgical outcomes compared to conventional freehand screw placement for patients undergoing one-to three-level lumbar fusion.

Advances in robotics and pediatric spine surgery

“…Studies comparing robotic usage to other techniques are limited to adult patients, but have found that the robot performs as well as any, or superior to, other methods in regards to accuracy, patient reported outcomes, and revision rates [3–5,11,14,15 ▪ ,16]. Katsevman et al [13 ▪ ] compared robot-guided screw placement to fluoroscopy-guided and found that the robotic screws had significantly less facet joint violation.…”

“…In most cases, robot-assisted pedicle screw placement is combined with surgical navigation so the operating surgeon can visualize the instrument trajectory in all planes and double-check the preplanned screw trajectory in real time [1 ▪▪ ,2,3,5,6]. Robot use in adult spinal surgery has been well documented and demonstrates comparable, if not superior, accuracy in placement of pedicle screws when compared to freehand, fluoroscopy-guided, or other navigated techniques [3–5,7 ▪▪ ,8,9,10 ▪ ,11,12 ▪ ,13 ▪ ,14,15 ▪ ,16].…”

A novel method to evaluate transverse pedicle angle of lower lumbar using digital radiography

“…Freehand pedicle screw xation during the operation is a universal and acceptable approach; [3][4][5] but despite that, a postoperative computed tomography (CT) study demonstrated that 3.9% of screw breach for free-hand pedicle screw technology was identi ed 6 . Another similar publication demonstrated 13.5% of misplace screw 5 .…”

Index Surgery Cost of Fluoroscopic Freehand Versus Robotic-Assisted Pedicle Screw Placement in Lumbar Instrumentation: An Age, Sex, and Approach-Matched Cohort Comparison

“… 15 Evidence that the use of robotics will lead to improved survival, function, and patient-reported outcomes and decreased complications is not consistent, and while there is some evidence of benefits over a fluoroscopic approach, many studies have shown equivalent or variable outcomes. 16 17 18 19 …”

“…15 Evidence that the use of robotics will lead to improved survival, function, and patient-reported outcomes and decreased complications is not consistent, and while there is some evidence of benefits over a fluoroscopic approach, many studies have shown equivalent or variable outcomes. [16][17][18][19] Spine surgery costs are notoriously high, and there are already criticisms and concerns over the economic effects. 20,21 Some studies have looked at overall costs, costs of different approaches to the spine, and geographic variation in costs; [22][23][24] however, there are few studies directly evaluating costs in robotic-assisted spine surgeries compared with more manual nonrobotic techniques.…”