Awake Robotic Minimally Invasive Transforaminal Lumbar Interbody Fusion Under Spinal Anesthesia: A Prospective Study with 1-Year Follow-up

Abstract

We describe our protocol and outcomes of awake robotic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anesthesia. We conducted a prospective study of 10 consecutive patients undergoing awake robotic single-level MIS-TLIF with the Mazor X robot. We prospectively collected patient-reported outcomes (back and leg pain visual analog scale and Oswestry Disability Index) preoperatively at 1-month and 1-year follow-ups and assessed fusion and screw placement accuracy with a 1-year computed tomography (CT) scan. Median age was 61 years (interquartile range [IQR]= 57.7-66). Median body mass index was 27 kg/m2. No intraoperative complications were reported. Most (9/10) patients were discharged home, and 50% discharged on the day of surgery. Median length of stay was 16.5 hours (IQR= 5-35.5). Median follow-up was 12.5 months (IQR= 12-13.5), with 9 patients having at least 12-month follow-up, with CT scans documenting good screw placement (Gertzbein-Robbins grade A) and solid bony fusion. Median preoperative back pain visual analog scale score was 7.8 (IQR= 6.9-8) versus 1.5 (IQR= 0-3.2) at 1-month post operation, P < 0.01, and 0 (IQR= 0-1) at 1-year follow-up, P < 0.01; median preoperative leg pain 8 (IQR= 7.4-8) versus 0 (IQR= 0-1.2) at 1-month post operation, P < 0.01, and 0 (IQR= 0-2) at 1-year follow-up, P < 0.01; median preoperative Oswestry Disability Index 47.5 (IQR= 27.8-57.5) versus 4 (IQR= 0-16) at 1-month postoperation, P < 0.01, and 0 (IQR= 0-7) at 1-year follow-up, P < 0.01. Median preoperative disk height of the index level was 8 mm (IQR= 2.4-9.5) versus 11.4 mm (IQR= 9.2-11.2) postoperatively,P < 0.01. Median preoperative lordosis of the index level was 5 degrees (IQR= 3.4-8.5) versus 10.1 degrees (7.3-12.2) postoperatively, P < 0.01. Our study showed significant improvement in patient-reported outcomes at 1-month and 1-year follow-ups after awake robotic MIS-TLIF, as well as solid bony fusion on CT scans.