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Robot-Navigated Pedicle Screw Insertion Can Reduce Intraoperative Blood Loss and Length of Hospital Stay: Analysis of 1,633 Patients Utilizing Propensity Score Matching – Lumbar Fusion

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This article investigates the use of robotically navigated pedicle screw insertion in spinal fusion surgery and its effectiveness in reducing perioperative complications. The study involved a retrospective analysis of patients who underwent primary lumbar fusion surgery between 2019 and 2022. The results showed that the robot-guided group had less estimated blood loss and shorter length of hospital stay compared to the freehand group. However, there were no significant differences in readmission rate, reoperation rate, and screw malposition requiring reoperation between the two groups. The study concludes that robot-guided pedicle screw insertion can enhance surgical efficiency without prolonging operative time

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

: Perioperative complications requiring readmission and reoperation were similar between fluoroscopy guided freehand and robotic surgery. Robot-guided pedicle screw insertion can enhance surgical efficiency by reducing intraoperative blood loss and length of hospital stay without extending operative time.

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Spine J. 2023 Sep 11:S1529-9430(23)03377-6. doi: 10.1016/j.spinee.2023.09.004. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Navigation and robotic technologies have emerged as an alternative option to conventional freehand techniques for pedicle screw insertion. However, the effectiveness of these technologies in reducing the perioperative complications of spinal fusion surgery remains limited due to the small cohort size in the,

Spine J. 2023 Sep 11:S1529-9430(23)03377-6. doi: 10.1016/j.spinee.2023.09.004. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Navigation and robotic technologies have emerged as an alternative option to conventional freehand techniques for pedicle screw insertion. However, the effectiveness of these technologies in reducing the perioperative complications of spinal fusion surgery remains limited due to the small cohort size in the existing literature.

PURPOSE: To investigate whether utilization of robotically navigated pedicle screw insertion can reduce the perioperative complications of spinal fusion surgery-including reoperations-with a sizeable cohort.

STUDY DESIGN: Retrospective study PATIENT SAMPLE: Patients who underwent primary lumbar fusion surgery between 2019 and 2022 OUTCOME MEASURES: Perioperative complications including readmission, reoperation, its reasons, estimated blood loss, operative time, and length of hospital stay METHODS: Patients’ data were collected including age, sex, race, body mass index (BMI), upper-instrumented vertebra (UIV), lower-instrumented vertebra (LIV), number of screws inserted, and primary procedure name. Patients were classified into the following two groups: freehand group and robot group. The variable-ratio greedy matching was utilized to create the matched cohorts by propensity score and compared the outcomes between the two group.

RESULTS: A total of 1,633 patients who underwent primary instrumented spinal lumbar fusion surgery were initially identified (freehand 1,286; robot 347). After variable ratio matching was performed with age, sex, BMI, fused levels, and upper instrumented vertebrae level, 694 patients in the freehand group and 347 patients in robot groups were selected. The robot group showed less EBL (418.9 ± 398.9 vs. 199.2 ± 239.6 ml; P< 0.001), shorter LOS (4.1 ± 3.1 vs. 3.2 ± 3.0 days; P<0.001) and similar operative time (212.5 vs. 222.0 min; P=0.151). Otherwise, there was no significant difference in readmission rate (3.6% vs. 2.6%; P=0.498), reoperation rate (3.2 % vs. 2.6 %; P=0.498), and screw malposition requiring reoperation (5 cases, 0.7% vs 1 case, 0.3%; P=1.000).

: Perioperative complications requiring readmission and reoperation were similar between fluoroscopy guided freehand and robotic surgery. Robot-guided pedicle screw insertion can enhance surgical efficiency by reducing intraoperative blood loss and length of hospital stay without extending operative time.

PMID:37704046 | DOI:10.1016/j.spinee.2023.09.004

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Robot-Navigated Pedicle Screw Insertion Can Reduce Intraoperative Blood Loss and Length of Hospital Stay: Analysis of 1,633 Patients Utilizing Propensity Score Matching

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Spine J. 2023 Sep 11:S1529-9430(23)03377-6. doi: 10.1016/j.spinee.2023.09.004. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Navigation and robotic technologies have emerged as an alternative option to conventional freehand techniques for pedicle screw insertion. However, the effectiveness of these technologies in reducing the perioperative complications of spinal fusion surgery remains limited due to the small cohort size in the

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