Improvement following minimally invasive transforaminal lumbar interbody fusion in patients aged 70 years or older compared with younger age groups

Shahi, Pratyush; Dalal, Sidhant; Shinn, Daniel; Song, Junho; Araghi, Kasra; Melissaridou, Dimitra; Sheha, Evan; Dowdell, James; Iyer, Sravisht; Qureshi, Sheeraz A.

doi:10.3171/2022.10.focus22604

Cited by 9 publications

(4 citation statements)

References 34 publications

(42 reference statements)

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“…Patients were split up into two cohorts based on the intraoperative modality: robotics (ExcelsiusGPS, Globus Medical Inc., Audubon, PA) and navigation (Stryker SpineMask, Stryker Corp., Kalamazoo, MI). The robotics and navigation workflows 12,13,15,16 and the MI-TLIF technique [17][18][19][20][21][22] were utilized, as previously described in the literature by our group.…”

Section: Methods Study Design and Patient Selectionmentioning

confidence: 99%

Comparison of Robotics and Navigation for Clinical Outcomes Following Minimally Invasive Lumbar Fusion

Shahi

Subramanian

Araghi

et al. 2023

Spine

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Study Design. Retrospective cohort. Objective. To compare navigation and robotics in terms of clinical outcomes after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data. Although robotics has been shown to have advantages like reduced radiation exposure, greater screw size, and slightly better accuracy over navigation, none of the studies has compared these two modalities in terms of clinical outcomes. Methods. Patients who underwent single-level MI-TLIF using robotics or navigation and had a minimum of 1-year follow-up were included. The robotics and navigation groups were compared for improvement in patient-reported outcome measures (PROMs), minimal clinically important difference, patient-acceptable symptom state, response on the global rating change scale, and screwrelated complication and reoperation rates. Results. A total of 278 patients (143 robotics, 135 navigation) were included. There was no significant difference between the robotics and navigation groups in the baseline demographics, operative variables, and preoperative PROMs. Both groups showed significant improvement in PROMs at below six and six months or above, with no significant difference in the magnitude of improvement between the two groups. Most patients achieved minimal clinically important difference and patient-acceptable symptom state and reported feeling better on the global rating change scale, with no significant difference in the proportions between the robotics and navigation groups. The screw-related complication and reoperation rates also showed no significant difference between the two groups. Conclusions. Robotics did not seem to lead to significantly better clinical outcomes compared with navigation following MI-TLIF. Although the clinical outcomes may be similar, robotics offers the advantages of reduced radiation exposure, greater screw size, and slightly better accuracy over navigation. These advantages should be considered when determining the utility and cost-effectiveness of robotics in spine surgery. Larger multicenter prospective studies are required in the future to further investigate this subject.

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Section: Methods Study Design and Patient Selectionmentioning

confidence: 99%

Comparison of Robotics and Navigation for Clinical Outcomes Following Minimally Invasive Lumbar Fusion

Shahi

Subramanian

Araghi

et al. 2023

Spine

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“…Surgeons 1 and 3 are early attendings who incorporated robotics at the beginning of their practice, whereas surgeon 2 is a more experienced surgeon who incorporated robotics after being in practice for over 10 years. MI-TLIF was performed as previously described in the literature 20–28 . The robot was used for pedicle screw insertion, retractor placement, disk space preparation, and cage insertion.…”

Section: Methodsmentioning

confidence: 99%

Surgeon Experience Influences Robotics Learning Curve for Minimally Invasive Lumbar Fusion

Shahi

Subramanian

Maayan

et al. 2023

Spine

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Study Design. Retrospective review of prospectively collected data. Objective. To analyze the learning curves of three spine surgeons for robotic minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data. Although the learning curve for robotic MI-TLIF has been described, the current evidence is of low quality with most studies being single-surgeon series. Materials and Methods. Patients who underwent single-level MI-TLIF with three spine surgeons (years in practice: surgeon 1: 4, surgeon 2: 16, and surgeon 3: two) using a floor-mounted robot were included. Outcome measures were operative time, fluoroscopy time, intraoperative complications, screw revision, and patient-reported outcome measures. Each surgeon’s cases were divided into successive groups of 10 patients and compared for differences. Linear regression and cumulative sum (CuSum) analyses were performed to analyze the trend and learning curve, respectively. Results. A total of 187 patients were included (surgeon 1: 45, surgeon 2: 122, and surgeon 3: 20). For surgeon 1, CuSum analysis showed a learning curve of 21 cases with the attainment of mastery at case 31. Linear regression plots showed negative slopes for operative and fluoroscopy time. Both learning phase and postlearning phase groups showed significant improvement in patient-reported outcome measures. For surgeon 2, CuSum analysis demonstrated no discernible learning curve. There was no significant difference between successive patient groups in either operative time or fluoroscopy time. For surgeon 3, CuSum analysis demonstrated no discernible learning curve. Even though the difference between successive patient groups was not significant, cases 11 to 20 had an average operative time of 26 minutes less than cases 1–10), suggesting an ongoing learning curve. Conclusions. Surgeons who are well-experienced can be expected to have no or minimal learning curve for robotic MI-TLIF. Early attendings are likely to have a learning curve of around 21 cases with the attainment of mastery at case 31. Learning curve does not seem to impact clinical outcomes after surgery. Level of Evidence. Level 3.

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“…(14) TLIF or LLIF was performed as described previously in the literature. [14][15][16][17][18][19][20] Robotic navigation was utilized for disc preparation and interbody placement. (15) Passage of rods under lateral fluoroscopy.…”

Section: Study Design and Populationmentioning

confidence: 99%

Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws

et al. 2023

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Objective: To analyze the usage of floor-mounted robot in minimally invasive lumbar fusion.Methods: Patients who underwent minimally invasive lumbar fusion for degenerative pathology using floor-mounted robot (ExcelsiusGPS) were included. Pedicle screw accuracy, proximal level violation rate, pedicle screw size, screw-related complications, and robot abandonment rate were analyzed.Results: Two hundred twenty-nine patients were included. Most surgeries were primary single-level fusion. Sixty-five percent of surgeries had intraoperative computed tomography (CT) workflow, 35% had preoperative CT workflow. Sixty-six percent were transforaminal lumbar interbody fusion, 16% were lateral, 8% were anterior, and 10% were a combined approach. A total of 1,050 screws were placed with robotic assistance (85% in prone position, 15% in lateral position). Postoperative CT scan was available for 80 patients (419 screws). Overall pedicle screw accuracy rate was 96.4% (prone, 96.7%; lateral, 94.2%; primary, 96.7%; revision, 95.3%). Overall poor screw placement rate was 2.8% (prone, 2.7%; lateral, 3.8%; primary, 2.7%; revision, 3.5%). Overall proximal facet and endplate violation rates were 0.4% and 0.9%. Average diameter and length of pedicle screws were 7.1 mm and 47.7 mm. Screw revision had to be done for 1 screw (0.1%). Use of the robot had to be aborted in 2 cases (0.8%).Conclusion: Usage of floor-mounted robotics for the placement of lumbar pedicle screws leads to excellent accuracy, large screw size, and negligible screw-related complications. It does so for screw placement in prone/lateral position and primary/revision surgery alike with negligible robot abandonment rates.

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Improvement following minimally invasive transforaminal lumbar interbody fusion in patients aged 70 years or older compared with younger age groups

Cited by 9 publications

References 34 publications

Comparison of Robotics and Navigation for Clinical Outcomes Following Minimally Invasive Lumbar Fusion

Comparison of Robotics and Navigation for Clinical Outcomes Following Minimally Invasive Lumbar Fusion

Surgeon Experience Influences Robotics Learning Curve for Minimally Invasive Lumbar Fusion

Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws

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