Does robot-assisted spine surgery for multi-level lumbar fusion achieve better patient-reported outcomes than free-hand techniques?

Abstract

To compare the patient-reported outcomes (PROs) between patients undergoing multilevel lumbar fusion with robot-assisted vs. freehand techniques. This was a single-institution cohort study of adult patients (≥18 years old) undergoing robot-assisted spine surgery from 2016 to 2018 with minimum 2-year follow-up. A propensity-score matching (PSM) algorithm accounted for several perioperative factors. PROs were measured using the Oswestry Disability Index (ODI). The minimum clinically important difference (MCID) between groups were assessed at each follow-up period (6-weeks/6-months/1-year/2-years). Chi-square/fisher exact test and t-test/ANOVA were used for categorical and continuous variables, respectively. After PSM, a total of 70 patients remained. The mean (standard deviation) charlson comorbidity index was 1.4 (1.0) and 57% of patients were female. The most common diagnoses included degenerative disc disease (37.1%), degenerative scoliosis (27.1%), and high grade spondylolisthesis (grade > 2) (19%), and the mean number of instrumented levels was 4.6 (4.4). Rates for intraoperative/postoperative complications, and any reoperation within 2 years after surgery were low and similar between groups. The baseline ODI scores were similar between freehand (39.1) and robot-assisted surgery (40.5, P-value = 0.736). By two years, substantial improvements in both groups (mean ODI-freehand: 4.6, robot-assisted: 1.5; MCID%-freehand: 77.1%, robot-assisted: 82.9%) were achieved, but not significantly different (P-value > 0.05). No differences were observed for the other follow-up periods. When comparing individual component scores, the robot-assisted group scored higher in “Lifting,” “Sitting,” and “Standing;” however, the magnitudes of these differences were less than 1 point. Robot-assisted multi-level lumbar fusion can achieve excellent and similar patient-reported outcomes to conventional freehand techniques. Future studies should include large, prospective randomized controlled trials as well as the inclusion of other patient reported outcome measures.