Robotic endoscopic transforaminal lumbar interbody fusion: A single institution case series

Abstract

Robotic-assisted, endoscopic transforaminal lumbar interbody fusion (RE-TLIF) is a promising, minimally invasive surgical option for degenerative lumbar spondylosis/spondylolisthesis; however, outcomes data and efficacy are limited, especially in multilevel disease. Here, we present the first reported series of patients that underwent either single or multilevel RE-TLIF. A retrospective review was performed on 23 consecutive patients who underwent a single level or multilevel RE-TLIF by a single surgeon. Variables included demographics, perioperative results, pain scores, and functional outcome scores. Eighteen patients (78.3%) underwent single level RE-TLIF and 5 patients (21.7%) underwent multilevel RE-TLIF. The median reduction of visual analog scale (VAS) for low back pain (LBP) of all subjects was 6 (IQR= 4.5, 6.5) with no significant difference between single level and multilevel RE-TLIF (p=.565). The median reduction of VAS for leg pain of all subjects 7 (IQR= 6, 8) with no significant difference between single level and multilevel RE-TLIF (p=.702). Median blood loss was 25 cc (IQR=25, 25) and 50 cc (IQR=25, 100) for single and multilevel RE-TLIF, respectively (p=.025), whereas median length of stay was 1 (IQR=1, 1; mean=1.0 ± .18) days and 1 (IQR=1, 2; mean=1.4 ± .54) days, respectively (p=.042). One major complication was observed requiring reoperation for demineralized bone matrix migration resulting in an L5 radiculopathy. Single and multi-level RE-TLIF appears to be a safe and efficacious approach with comparable outcomes to open and other minimally invasive approaches. Additionally, we observed favorable accuracy in robot-assisted pedicle screw, endoscope, and interbody device placement.