44. Does robotic vs freehand screw placement affect patient reported outcomes in 1-3 level lumbar fusion?

Abstract

<h3>BACKGROUND CONTEXT</h3> Studies have shown robotically-assisted surgery demonstrates increased pedicle screw accuracy when compared to conventional freehand surgery. However, little research has been done to determine if this increased accuracy translates to improved clinical outcomes. <h3>PURPOSE</h3> The purpose of this study is to compare patient reported outcome measures (PROMs) for patients undergoing one to three level lumbar fusion using robotically-assisted vs freehand screw placement. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Patients who underwent either robotically-assisted or freehand lumbar fusion surgery of one to three levels from January 1, 2014 to August 31, 2020. <h3>OUTCOME MEASURES</h3> Oswestry Disability Index (ODI), Form-12 Physical (PCS-12) and Mental (MCS-12) Composite scores, visual analogue scale (VAS) back and leg scores, incidence of revisions and surgical complications. <h3>METHODS</h3> Clinical and surgical outcomes were compared between groups. Recovery ratios (RR) and the number of patients achieving the minimally clinically important difference (MCID) were calculated for ODI, PCS-12, MCS-12, VAS Back and VAS Leg at 1-year postoperative. Surgical outcomes included complication and revision rates. Multivariate linear regression analysis was performed to determine the effect of surgery type (robotically assisted or freehand) on PROMs, controlling for age, gender, BMI and number of levels fused. <h3>RESULTS</h3> A total of 262 patients were included in the study, 85 robotically-assisted and 177 freehand. No significant differences were found in ∆PROM scores, RR, or MCID between patients who underwent robotically-assisted vs freehand screw placement. The rates of revisions (1.70% in freehand group vs 1.18% in robotic group, p = 1.000) and complications (1.10% in freehand vs 1.18% in robotic group, p=1.000) between the two groups were not statistically significant. Controlling for demographic factors, procedure type (robot vs freehand) did not emerge as a significant predictor of ∆PROM scores on multivariate linear regression analysis. <h3>CONCLUSIONS</h3> Robotically-assisted screw placement did not result in significantly improved clinical or surgical outcomes compared to conventional freehand screw placement. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.