239. Comparison of single-position robot-assisted surgery vs conventional minimally invasive surgery following LLIF: an in vitro assessment

Abstract

BACKGROUND CONTEXT Lateral lumbar interbody fusion (LLIF) provides indirect decompression of the neural elements while minimizing the potential vascular complications associated with anterior lumbar interbody fusion (ALIF). Posterior fixation may be applied through various techniques such as conventional minimally invasive surgery (CMIS), requiring the patient to be repositioned prone to provide access to both pedicles. Conversely, robot-assisted navigation (RAN) of pedicle screws can be utilized from a single position without flipping the patient. RAN is theorized to reduce patient surgical time, radiation, and blood loss due to positioning and workflow effects. PURPOSE To evaluate the effect of robot-assisted navigation in comparison to CMIS methods in terms of surgical time, radiation exposure, and pedicle screw accuracy. STUDY DESIGN/SETTING Cadaveric study. PATIENT SAMPLE N/A OUTCOME MEASURES N/A METHODS Twelve unembalmed human torsos were implanted with 2-level static LLIF cages, followed by posterior bilateral pedicle screw fixation using either CMIS (n=6) or RAN (n=6). Preoperative computed tomography (CT) RAN workflow utilized CT scans of the specimen taken offsite and transferred to the robotic system during setup. Screw planning was performed using these CT scans, and then was merged with intraoperative fluoroscopy. Surgical times, surgeon radiation exposure, and screw accuracy were measured. Patient flip time from a consecutive patient series was included. RESULTS Significant differences in surgical times and radiation dosages were found between groups. Surgical time for preoperative RAN and CMIS was 64.7 min±4.1 min and 123.0 min±13.7 min, respectively. Time per screw for RAN and CMIS workflows was 2.7±0.6 min and 4.3±1.3 min, respectively. RAN was significantly different for total operative time and time per screw in comparison to CMIS (p CONCLUSIONS Significant differences were found in both surgical time and radiation exposure between CMIS and RAN, with RAN resulting in shorter surgical times and less radiation exposure to the surgeon than CMIS. Consideration should be given to single-position LLIF procedures that utilize RAN to instrument the spine with bilateral pedicle screws. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.