Abstract
Studies evaluating robotic guidance in lumbar fusion are limited primarily to evaluation of screw accuracy and perioperative complications. This is the first study to evaluate granular differences in short and long-term complication and revision rate profiles between robotic (RG) fluoroscopic (FG) guidance for minimally invasive short-segment lumbar fusions. A retrospective analysis of a prospective, multi-center database was performed. Complications were subdivided into surgical (further subcategorized into adjacent segment disease, new-onset back pain, radiculopathy, motor-deficit, hardware failure, pseudoarthrosis), wound, and medical complications. Complication and revision rates were compared between RG and FG groups cumulatively at 30, 90 days, and 1 year. 374 RG and 111 FG procedures were performed. RG was associated with an 86.25, 83.20, and 69.42% cumulative reduction in complication rate at 30, 90 days, and 1 year, respectively, compared to FG (p < 0.001). At all follow-up points, new-onset radiculopathy and medical complications were most prevalent in both groups. The greatest reductions in complication rates were seen for new-onset back pain (88.13%; p = 0.001) and wound complications (95.05%; p < 0.001) at 30 days, new-onset motor deficits (90.11%; p = 0.004) and wound complications (85.16%; p < 0.001) at 90 days, and new-onset motor deficits (85.16%; p = 0.002), wound (85.16%; p < 0.001), and medical complications (75.72%; p < 0.001) at 1 year. RG was associated with a 92.58% (p = 0.002) reduction in revision rate at 90 days and a 66.08% (p = 0.026) reduction at 1 year. RG was associated with significant reductions in postoperative complication rates at all follow-up time points and significant reductions in revision rates at 90 days and 1 year.
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Funding
MISReFRESH received direct funding from Mazor Robotics, Ltd. and Medtronic PLC. This sub-analysis of the MISReFRESH database received funding from Medtronic PLC.
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All authors contributed to the study conception and design. Material preparation and data collection were performed by JIL, VK, AJ, CRG, SRS, AC, VH, JL, FZ, PMR, TMS, and MYW. Data analysis was performed by ZS, JIL, VK, and AJ. The first draft of the manuscript was written by JIL, VK, AJ, and MYW. All authors commented on and participated in multiple manuscript revisions, culminating in the final manuscript. All authors read and approved the final manuscript.
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Dr. Liounakos: nothing to disclose. Dr. Kumar: nothing to disclose. Dr. Jamshidi: nothing to disclose. Ms. Silman: nothing to disclose. Dr. Good: consultant for Medtronic, Stryker/K2M. Receives royalties from Stryker/K2M. Member of scientific advisory boards for Medtronic, Stryker/K2M, Augmedics. Holds direct stock ownership in Augmedics. Member of board of directors for National Spine Health Foundation. Dr. Schroerlucke: consultant for NuVasive. Receives royalties from NuVasive. Receives research support from Mazor Robotics, Ltd/Medtronic. Dr. Cannestra: consultant for Alphatec, Alliance Spine, Integrity Implants, Spinal Elements, MiRus, NuVasive, RTI, Mazor Robotics Ltd/Medtronic. Receives royalties from Alphatec, Alliance Spine, RTI, Spinal Elements, NuVasive. Receives research funding from NuVasive, Mazor Robotics Ltd/Medtronic. Dr. Hsu: consultant for Medtronic. Receives royalties from Camber Spine, Medicrea. Dr. Lim: consultant for Nexxt Spine, Stryker/K2M. Receives royalties from Globus Medical. Dr. Zahrawi: receives royalties from Spinewave. Dr. Ramirez: consultant for Spine Wave, Captiva Spine, SI Bone. Research support for Mazor Robotics, Ltd/Medtronic. Dr. Sweeney: receives royalties from NuVasive. Receives income from sales of intellectual property from Alpine Spine, LLC. Previously served as a consultant for Mazor Robotics, Ltd. Dr. Wang: consultant for Depuy-Synthes Spine, Spineology, Stryker. Receives royalties from the Children’s Hospital of Los Angeles, Depuy-Synthes Spine, Springer Publishing, Quality Medical Publishing. Member of speaker’s bureau for Medtronic, Globus Medical. Holds direct stock ownership in Innovative Surgical Devices, Medical Device Partners.
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This retrospective analysis of a prospectively collected database (MISReFRESH; ClinicalTrials.gov Identifier: NCT02057744) involving human participants was performed in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of each respective institution involved approved this research investigation.
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Liounakos, J.I., Kumar, V., Jamshidi, A. et al. Reduction in complication and revision rates for robotic-guided short-segment lumbar fusion surgery: results of a prospective, multi-center study. J Robotic Surg 15, 793–802 (2021). https://doi.org/10.1007/s11701-020-01165-5
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DOI: https://doi.org/10.1007/s11701-020-01165-5