Letter to the Editor regarding “Risk of Postoperative Complications and Revision Surgery Following Robot-assisted Posterior Lumbar Spinal Fusion”

Abstract

We read with great interest the study by Yang et al, which compared outcomes and complications between robotic-assisted and conventional lumbar fusions. Although we commend the authors for tackling a complex topic using a large administrative database, it was surprising that the observed rate of complications is higher for robotic spinal fusions as outcomes for robotic-assisted procedures are usually similar, if not better, when compared to conventional open surgeries.1,2 The study's methodology introduces questions about the presented data and conclusion. The authors have identified robotic fusions using billing codes for fluoroscopic (CPT-0054T), CT/MRI (CPT-0055T), image-less (CPT-20985), and stereotactic (CPT-61783) computer-assisted navigation. This presents an issue as robotic-assisted surgery is considered to be incidental to the primary procedure and is not uniquely identified with a unique CPT code. Therefore, a significant portion of the procedures captured in this analysis might not be robotic procedures, but instead are various forms of navigation-assisted fusions. The authors also discuss stratifying their analysis based on the number of levels, but there is no separate analysis or multivariate analysis that shows a stratification and/or adjustment for the length of fusion. Therefore, the significantly higher rate of complications observed for robotic fusions could arise from procedures done for long-segment fusions, and/or spinal deformity that would preclude an easy placement of free-hand pedicle screw placement.