200. Comparison of freehand, fluoro-guided, CT navigation, and robot-guided TLIF and ALIF

Abstract

BACKGROUND CONTEXT Screw placement in transforaminal interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) can be done with open free hand (FH), fluoroscopy-guided (FG), spinal navigation (NAV), or robotic guided (RG) techniques. Varied techniques may affect perioperative (periop) outcomes. Few studies compare all four guidance techniques. PURPOSE Compare the perioperative outcomes between FH, FG, NAV, and RG TLIF and ALIF. STUDY DESIGN/SETTING Single center retrospective cohort study PATIENT SAMPLE A total of 1,646 patients who underwent 1-2 level TLIF or 1-3 level ALIF from 2012-2019. OUTCOME MEASURES Outcomes: registration failure, operative time (OT), radiation dosage (RD), estimated blood loss (EBL), length of stay (LOS), and periop complications, and retursn to OR up to 90 days. METHODS Patients undergoing 1-2 level TLIF or 1-3 level ALIF were included. Analysis of variance (ANOVA) and χ2test were used to analyze differences in outcomes with significance set at p RESULTS A total of 1,202 1-2 level TLIFs were included (843 FH, 175 FG, 40 NAV, 144 RG) TLIFS. 444 1-3 level ALIFs were included: 337 FH, 25 FG, and 80 RG ALIFs. Demographics were similar amongst ALIF cohorts except significantly more FH-ALIF smokers and TLIF cohorts after propensity matching for levels fused. Amongst the TLIF Cohorts: OT and LOS longest in NAV (291.67±89.85 min; p CONCLUSIONS NAV-TLIF had significantly differences in EBL, RD, periop complications, and return to OR 30 days. PSM for levels fused show postop complications rate remain significant with other factors and radiographic dosage remaining significant. RG TLIF and RG ALIF had the worst perioperative complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.