Clinical Outcomes and Cost-effectiveness of Robotic-assisted versus Non-robotic Surgery in Traumatic Spine Injury

Introduction: Robotic-assisted spine surgery (RASS) first gained FDA approval in 2004 and despite nearly two decades of advancement, is still in its early stages of development (D’Souza et al., 2019). Due to the initial cost of development and technical expertise required to operate robotic instrumentation, the price of RASS is more than a conventional free-hand spine surgery (FHSS) (Passias et al., 2021). This study aims to explore the clinical outcomes following RASS in traumatic spine injury to assess whether they justify the increased cost.

Methods: The National Trauma Data Bank was queried from 2017 to 2019 for all patients undergoing cervical, thoracic, and lumbar spine surgery following traumatic spinal column injury. Patients were grouped into those receiving RASS and those receiving FHSS. Student’s t-tests and chi-squared tests were used to compare differences in patient demographics, in-hospital complications, length of stay, and mortality rates for the two groups.

Results: 189 patients matched the inclusion criteria for RASS compared to 83,946 patients for FHSS. The robotic-assisted group had a higher percentage of Native Hawaiian/Pacific Islander patients (1.06% vs. 0.25%, p=0.029), but all other demographic factors including age and sex were comparable between the two groups. There were no statistically significant differences in any of the in-hospital complications assessed, including surgical site infection, deep vein thrombosis, pulmonary embolism, stroke, unplanned admission to ICU, and reoperation. There were also no differences in hospital length of stay and mortality rates.

Conclusion : RASS does not improve short-term postoperative outcomes compared to FHSS in traumatic spine injuries. Given the greater cost of RASS, these results suggest that FHSS should be preferred in traumatic spine injuries. Investigation into long-term outcomes, patient quality of life, procedure length, and post-surgical pain scores is warranted to determine the long-term benefits of RASS.