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. 2023 Sep;13(7):1871-1877.
doi: 10.1177/21925682211057491. Epub 2021 Dec 7.

Clinical Outcomes of Robotic Versus Freehand Pedicle Screw Placement After One-to Three-Level Lumbar Fusion

Brian A Karamian  1 , Stephen L DiMaria  1 , Andrew N Sawires  1 , Jose A Canseco  1 , Bryce A Basques  1 , Gregory R Toci  1 , Kris E Radcliff  1 , Jeffrey A Rihn  1 , I David Kaye  1 , Alan S Hilibrand  1 , Joseph K Lee  1 , Christopher K Kepler  1 , Alexander R Vaccaro  1 , Gregory D Schroeder  1
Affiliations

Clinical Outcomes of Robotic Versus Freehand Pedicle Screw Placement After One-to Three-Level Lumbar Fusion

Brian A Karamian et al. Global Spine J. 2023 Sep.

Abstract

Study design: Retrospective cohort study.

Objectives: The purpose of this study is to compare patient-reported outcome measures (PROMs) for patients undergoing one-to three-level lumbar fusion using robotically assisted vs freehand pedicle screw placement.

Methods: Patients who underwent either robotically assisted or freehand pedicle screw placement for one-to three-level lumbar fusion surgery from January 1, 2014 to August 31, 2020 at a single academic institution were identified. Propensity score matching was performed based on demographic variables. Clinical and surgical outcomes were compared between groups. Recovery Ratios (RR) and the proportion of patients achieving the minimally clinically important difference (%MCID) were calculated for Oswestry Disability Index, PCS-12, MCS-12, VAS Back, and VAS Leg at 1 year. Surgical outcomes included complication and revision rates.

Results: A total of 262 patients were included in the study (85 robotic and 177 freehand). No significant differences were found in ΔPROM scores, RR, or MCID between patients who underwent robotically assisted vs freehand screw placement. The rates of revision (1.70% freehand vs 1.18% robotic, P = 1.000) and complications (.57% freehand vs 1.18% robotic, P = .546) were not found to be statically different between the 2 groups. Controlling for demographic factors, procedure type (robotic vs freehand) did not emerge as a significant predictor of ΔPROM scores on multivariate linear regression analysis.

Conclusions: Robotically assisted pedicle screw placement did not result in significantly improved clinical or surgical outcomes compared to conventional freehand screw placement for patients undergoing one-to three-level lumbar fusion.

Keywords: lumbar fusion; navigation; patient-reported outcomes; pedicle screw placement; robotically assisted surgery.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Li HM, Zhang RJ, Shen CL. Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis. Spine. 2020;45(2):E111. - PubMed
    1. Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bünger CE. 1997 Volvo Award winner in clinical studies: the effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study. Spine. 1997:22(24):2813. - PubMed
    1. France JC, Yaszemski MJ, Lauerman WC, et al. A randomized prospective study of posterolateral lumbar fusion: outcomes with and without pedicle screw instrumentation. Spine. 1999;24(6):553-560. - PubMed
    1. Sarwahi V, Wendolowski SF, Gecelter RC, et al. Are we underestimating the significance of pedicle screw misplacement? Spine. 2016;41(9):E548-E555. - PubMed
    1. Castro WH, Halm H, Jerosch J, Malms J, Steinbeck J, Blasius S. Accuracy of Pedicle Screw placement in lumbar vertebrae. Spine. 1996:21(11):247–255. - PubMed

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