A study presented at the Society of Minimally Invasive Spine Surgery Annual Forum 2016 examined the surgical outcomes for robotic-guided spine surgery and compared them with patients who underwent the procedure with freehand instrumentation.
The study authors also compared minimally invasive and open procedures. The researchers gathered data from four surgeons who either used robotic guidance during a minimally invasive approach; an MIS procedure with fluoroscopic guidance; or an open approach. All of the surgeries were instrumented fusions; the minimally invasive techniques inserted the pedicle screws through a percutaneous para-median approach and for the open procedures surgeons used median dissection.
There were 705 patients included in the study; 403 robotic guided procedures, 224 fluoroscopic guided procedures and 78 freehand procedures. The researchers found:
1. The complication rates for the techniques were:
• Robotic guidance: 4 percent
• Fluoroscopic guidance: 5.4 percent
• Freehand: 12.8 percent
2. The revision rate was similar between the robotic and fluoroscopic guidance groups — around 3.8 percent — compared with the freehand group — 7.7 percent.
3. The odds for surgical complications were higher among the freehand group than the fluoroscopic guidance group.
4. The odds for revision were higher — 3.8 — among the fluoroscopic group than the freehand group — 1.9 — but the researchers reported the difference wasn't statistically significant due to the small sample size in the freehand group.
5. The researchers didn't find a difference among the patients based on surgeon, patient age, gender, BMI or the length of surgery.
"This retrospective analysis demonstrated that use of robotic guidance MIS can significantly reduce surgical complications and revision surgeries when compared to fluoro-guided MIS in the hands of experienced MIS surgeons," concluded the study authors.