Resident Mayo Clinic Jacksonville, Florida, United States
Introduction: There has recently been increasing interest in the use of spinal anesthesia for spine surgery. The aim of this prospective study is to describe our protocol and outcomes of awake robotic minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anesthesia.
Methods: We enrolled 10 consecutive patients undergoing awake MIS-TLIF under spinal anesthesia by a single surgeon with the Mazor X robot. We prospectively collected patient-reported outcomes (PROs) (back and leg pain VAS, and Oswestry Disability Index) before the surgery and at the one-month follow-up. We also collected demographics and periprocedural data.
Results: Median age was 61 years (57.7-66) (IQR); 60% of patients were female; median BMI 27 kg/m2 (25.3-29.3); 70% were ASA class 2, 30% ASA class 3. No intraoperative complications were reported. 9/10 patients were discharged home, one patient was discharged to short-term rehab (STR). 50% of patients were discharged on the day of surgery. Median length of stay was 16.5 hours (5-35.5); excluding the patient that was waiting for STR placement, the median length of stay was 8h. Median EBL was 35ml (35-50). Median follow-up was 4 months (3-7.5), with 2 patients having a 12-month follow-up with CT scans documenting good screw placement and solid bony fusion. Median operative time was 112 minutes (107-132.7); median total OR time was 160.5 minutes (144.7-181.7). Median VAS pain score in the PACU was 4.2 (2.7-5.9). Median time to first ambulation was 279 minutes (237.5-395.5). Median pre-op back pain VAS was 7.8 (6.9-8) versus 1.5 (0-3.2) 1-month post-op, p< 0.001; median preop worse leg pain was 8 (7.4-8) versus 0 (0-1.2) at 1-month post-op, p< 0.001; median preop ODI was 47.5 (27.8-57.5) versus 4 (0-16) at 1-month post-op, p< 0.001.
Conclusion : Our study showed significant improvement in PROs at 1-month follow-up after awake robotic MIS-TLIF, as well as reduced OR times and faster ambulation.
