Interdisciplinary Neurosurgery (Sep 2021)
Clinical and patient-reported outcomes after robot-assisted short-segment lumbar fusion with a minimum 1-year follow-up
Abstract
Objective: To examine the complications and patient-reported outcomes after robot-assisted short-segment lumbar fusion surgery. Methods: We reviewed a consecutive group of adult patients (≥18 years old) with lumbar degenerative disease who underwent a robot-assisted short lumbar fusion (1-, 2-level) between 2017 and 2019. The minimum follow-up was 1-year. Bivariate and multivariate analyses were performed to determine risk factors for the outcomes. Results: A total of 51 patients underwent a robot-assisted short-segment (1-level: N = 33, 64.7%; 2-level: N = 18, 35.3%) lumbar fusion. The mean age ± standard deviation was 55.4 ± 12.9, and 52.9% of patients were female (N = 27). Intraoperative complications included dural tear (N = 3, 5.9%) and exchange of screws for breach (N = 3, 5.9%). No intraoperative motor/sensory loss was observed in this study sample. The mean length of stay was 2.8 ± 1.6 days. The 1-year readmission and reoperation rates were 11.8% (N = 6) and 7.8% (N = 4), respectively. The reasons for revision surgeries included wound complications requiring irrigation and debridement (N = 3) and disc herniation (N = 1, 2%). Overall, our patients experienced substantial improvements in ODI (MCID%: 6-weeks: 60.1%, 6-month: 78.8%, 1-year: 85.4%, and 2-year: 85.7%). For primary 1-level lumbar fusion, there was a significant reduction of 40 min after the first 20 cases (193 ± 30 min vs. 153 ± 55, p = 0.019). Conclusions: The findings of our study on robot-assisted short-segment lumbar fusions demonstrate that comparable outcomes can be achieved with robotic assistance compared to those reported for both free-hand technique and other robotic systems in current literature. Most patients can expect to achieve substantial improvements in their PROs despite complications. Even after the first 20 cases, surgeons might experience a significant reduction in operative time using this robotic system.
