Perioperative Comparison of Robotic-Assisted Versus Fluoroscopically Guided Minimally Invasive Transforaminal Lumbar Interbody Fusion

Biase, Gaetano De; Gassie, Kelly; Garcia, Diogo; Abode-Iyamah, Kingsley; Deen, Gordon; Nottmeier, Eric W.; Chen, Selby

doi:10.1016/j.wneu.2021.01.133

Cited by 29 publications

(16 citation statements)

References 25 publications

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“…[1][2][3][4][5] Recent prog-ress in spine surgery includes the use of the endoscope, robot-assisted screw placement, and navigation guidance. 6,7 With the goal of improving outcomes and accelerating patient recovery, there has been increasing interest in the use of spinal anesthesia (SA) in spine surgery, particularly for ABBREVIATIONS ASA =…”

mentioning

confidence: 99%

Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation

Biase

Gruenbaum

West

et al. 2021

Neurosurgical Focus

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OBJECTIVE There has been increasing interest in the use of spinal anesthesia (SA) for spine surgery, especially within Enhanced Recovery After Surgery (ERAS) protocols. Despite the wide adoption of SA by the orthopedic practices, it has not gained wide acceptance in lumbar spine surgery. Studies investigating SA versus general anesthesia (GA) in lumbar laminectomy and discectomy have found that SA reduces perioperative costs and leads to a reduction in analgesic use, as well as to shorter anesthesia and surgery time. The aim of this retrospective, case-control study was to compare the perioperative outcomes of patients who underwent minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF) after administration of SA with those who underwent MIS-TLIF under GA. METHODS Overall, 40 consecutive patients who underwent MIS-TLIF by a single surgeon were analyzed; 20 patients received SA and 20 patients received GA. Procedure time, intraoperative adverse events, postoperative adverse events, postoperative length of stay, 3-hour postanesthesia care unit (PACU) numeric rating scale (NRS) pain score, opioid medication, and time to first ambulation were collected for each patient. RESULTS The two groups were homogeneous for clinical characteristics. A decrease in total operating room (OR) time was found for patients who underwent MIS-TLIF after administration of SA, with a mean OR time of 156.5 ± 18.9 minutes versus 213.6 ± 47.4 minutes for patients who underwent MIS-TLIF under GA (p < 0.0001), a reduction of 27%. A decrease in total procedure time was also observed for SA versus GA (122 ± 16.7 minutes vs 175.2 ± 10 minutes; p < 0.0001). No significant differences were found in intraoperative and postoperative adverse events. There was a difference in the mean maximum NRS pain score during the first 3 hours in the PACU as patients who received SA reported a lower pain score compared with those who received GA (4.8 ± 3.5 vs 7.3 ± 2.7; p = 0.018). No significant difference was observed in morphine equivalents received by the two groups. A difference was also observed in the mean overall NRS pain score, with 2.4 ± 2.1 for the SA group versus 4.9 ± 2.3 for the GA group (p = 0.001). Patients who received SA had a shorter time to first ambulation compared with those who received GA (385.8 ± 353.8 minutes vs 855.9 ± 337.4 minutes; p < 0.0001). CONCLUSIONS The results of this study have pointed to some important observations in this patient population. SA offers unique advantages in comparison with GA for performing MIS-TLIF, including reduced OR time and postoperative pain, and faster postoperative mobilization.

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mentioning

confidence: 99%

Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation

Biase

Gruenbaum

West

et al. 2021

Neurosurgical Focus

Self Cite

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“…So far, several literature have been published to evaluate the accuracy and clinical outcomes with utilization of orthopaedic robot in posterior cervical surgery and thoracolumbar surgery [14,[27][28][29]. At present, there is an increasing number of studies focusing on the combination of robot with MIS-TLIF technique in the treatment of lumbar degenerative disease [16][17][18][19]26,30]. These studies showed better or non-inferior screw accuracy and perioperative outcomes compared with freehand or fluoroscopy-guided techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the robotic system could be particularly suitable for minimally invasive surgical procedures. However, the sample volume and follow-up data of previous clinical reports were limited [16][17][18][19]. Hence, additional evidence such as long-term follow-up was still needed to evaluate the value of robotic assistance in clinical practice.…”

mentioning

confidence: 99%

Robot-assisted minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a retrospective matched-control analysis for clinical and quality-of-life outcomes

et al. 2021

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Aim: To compare the screw accuracy and clinical outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and open TLIF in the treatment of one-level lumbar degenerative disease. Materials & methods: From May 2018 to December 2019, a consecutive series of patients undergoing robot-assisted minimally invasive one-level lumbar fusion procedures were retrospectively compared with matched controls who underwent one-level open TLIF procedures for clinical and quality-of-life outcomes. Results: A total of 52 patients underwent RA MIS-TLIF procedures (robot-assisted [RA] group) and 52 matched controls received freehand open TLIF procedures (open [OP] group). The RA group had more grade A screws with 96.2% one-time success rate of screw placement (p < 0.05). Besides, the RA group experienced less intraoperative blood loss and shorter length of hospital stay, while the OP group had shorter operative duration and cumulative radiation time (p < 0.001). What is more, the average VAS score for low back pain and ODI score in the RA group were lower than that in the OP group 1 month after operation (p < 0.05). Conclusion: The use of real-time, image-guided robot system may further expand the advantages of MIS-TLIF technique in terms of accuracy and safety.

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“…The spinal cord, nerve root, vessels, and abdominal and thoracic viscera surround the pedicle, and placement of screws into the pedicle of the vertebrae includes a risk of catastrophic complications from a misplaced screw 16 . The risks associated with lumbar fusion surgery include nerve injury, paralysis, radiation exposure, damage to the posterior spinal elements, inaccuracy of screw placement, and postoperative pain 17 …”

Section: Lumbar Fusion Overviewmentioning

confidence: 99%

“…The patient’s length of stay may be shortened after robotic‐assisted surgery because of the decreased disruption of structures in the surgical wound bed. However, results of available studies show mixed results related to length of stay 17,23 that may be associated with the number of involved spinal levels or the type and amount of instrumentation used.…”

Section: Lumbar Fusion Overviewmentioning

confidence: 99%

Robotic‐Assisted Lumbar Fusion: An Effective Technique for Pedicle Screw Placement

Karasin¹,

Rizzo²,

Hardinge³

et al. 2022

AORN Journal

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Degenerative lumbar disease is a common condition in which progressive deterioration of the structures in the spine causes severely incapacitating pain and disability. Conservative management, including passive or active physical therapy, activity modification, and medications (eg, anti‐inflammatory medications, oral and injectable steroids, opioids), may provide relief. However, when conservative management is unsuccessful or patients experience symptoms for an extended period of time, they may require spine surgery. Surgeons use a variety of techniques to perform lumbar fusion procedures with instrumentation, including open, percutaneous, minimally invasive, and robotic‐assisted with navigation. The accuracy of pedicle‐screw placement varies according to the technique used, and accuracy rates are high after robotic‐assisted with navigation procedures. In addition, robotic‐assisted spine procedures result in fewer infections than non–robotic‐assisted spine procedures (P = .04). Perioperative nurses should understand basic lumbar spine anatomy, steps completed during robotic‐assisted lumbar spine surgery, and the nursing considerations for patients undergoing this type of procedure.

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Perioperative Comparison of Robotic-Assisted Versus Fluoroscopically Guided Minimally Invasive Transforaminal Lumbar Interbody Fusion

Cited by 29 publications

References 25 publications

Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation

Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation

Robot-assisted minimally invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion: a retrospective matched-control analysis for clinical and quality-of-life outcomes

Robotic‐Assisted Lumbar Fusion: An Effective Technique for Pedicle Screw Placement

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