239. Comparison of single-position robot-assisted surgery vs conventional minimally invasive surgery following LLIF: an in vitro assessment

• Published in: The spine journal 2020-09, Vol.20 (9), p.S118-S118
• Main Authors: Protopsaltis, Themistocles S., Larson, Jeffrey J., Frisch, Richard F., Huntsman, Kade T., Lansford, Todd J., Brady, Robert L., Maulucci, Chris, Hayward, Gerald, Harris, Jonathan, Gonzalez, Jorge, Bucklen, Brandon
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2020.05.650

Lateral lumbar interbody fusion (LLIF) provides indirect decompression of the neural elements while minimizing the potential vascular complications associated with anterior lumbar interbody fusion (ALIF). Posterior fixation may be applied through various techniques such as conventional minimally invasive surgery (CMIS), requiring the patient to be repositioned prone to provide access to both pedicles. Conversely, robot-assisted navigation (RAN) of pedicle screws can be utilized from a single position without flipping the patient. RAN is theorized to reduce patient surgical time, radiation, and blood loss due to positioning and workflow effects. To evaluate the effect of robot-assisted navigation in comparison to CMIS methods in terms of surgical time, radiation exposure, and pedicle screw accuracy. Cadaveric study. N/A N/A Twelve unembalmed human torsos were implanted with 2-level static LLIF cages, followed by posterior bilateral pedicle screw fixation using either CMIS (n=6) or RAN (n=6). Preoperative computed tomography (CT) RAN workflow utilized CT scans of the specimen taken offsite and transferred to the robotic system during setup. Screw planning was performed using these CT scans, and then was merged with intraoperative fluoroscopy. Surgical times, surgeon radiation exposure, and screw accuracy were measured. Patient flip time from a consecutive patient series was included. Significant differences in surgical times and radiation dosages were found between groups. Surgical time for preoperative RAN and CMIS was 64.7 min±4.1 min and 123.0 min±13.7 min, respectively. Time per screw for RAN and CMIS workflows was 2.7±0.6 min and 4.3±1.3 min, respectively. RAN was significantly different for total operative time and time per screw in comparison to CMIS (p