Spine Surgeon NYU School of Medicine New Canaan, CT, US
Introduction: Robot-assisted surgical techniques are being increasingly implemented in spine surgery to increase accuracy and mitigate surgeon stamina. There are known variations in the learning curve required for effective use however literature on the effect of robot-assisted techniques on perioperative outcomes, after overcoming the learning curve, remains scarce.
Methods: Robot-assisted spinal fusion cases with baseline and up to two-year HRQL and radiographic follow-up were isolated from a single- surgeon database. Cases were ranked by the date of surgery into 2 halves, Early vs Late. Univariate analysis was used to assess baseline, surgical, and radiographic profiles of the 2 cohorts.
Results: 230 patients met inclusion criteria. The Late group was older, had a higher CCI, greater number of levels fused, greater usage of interbodies, more laminectomies, less decompressions and more osteotomies, lower usage of ALIF, higher usage of XLIF/LLIF, lower usage of TLIF. The Late group had a lower EBL, shorter op-time, and comparable LOS. The Late group had a lower rate of discharge to rehab(8% vs 50%, p < .001). Rate of reoperations, readmissions, and overall complications trended lower in the Late group. At BL, Late group had a comparable ODI, and BL NRS Back. At 3M, Late group had a lower ODI(48 vs 59 ,p=.114) and comparable NRS Back(5 vs 5.8, p=.3). At two-year follow-up, patients in the Late group had a lower ODI(34 vs 42), lower NRS Back(3.9 vs 5.2), and lower NRS Leg(3.14 vs 4.2).
Conclusion : Patients operated on in the second half of surgeons full robotic case load demonstrated an improved periop course in the form of a shorter LOS, lower EBL, shorter operative time, and a substantial reduction in discharge to rehab. Outcomes at two-years show superior recovery as evidenced by lower pain and ODI scores. These findings suggest once the robotic learning curve is overcome, outcomes substantially improve.
