Robotic-Assisted Versus Navigation-Assisted Posterior Lumbar Fusion : A National Database Study.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY Spine Pub Date : 2024-11-01 Epub Date: 2024-05-08 DOI:10.1097/BRS.0000000000005032

Michael J Gouzoulis, Anthony E Seddio, Adam D Winter, Sahir S Jabbouri, Justin R Zhu, Daniel R Rubio, Arya G Varthi, Jonathan N Grauer

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Abstract

Study design: Retrospective cohort study.

Objective: The aim of this study was to compare perioperative adverse events and reoperations between navigation-assisted and robotic-assisted posterior lumbar fusion.

Summary of background data: Navigation has become increasingly utilized for posterior lumbar fusion (PLF). More recently, robotic-assisted systems have been gaining traction. However, the incremental advantage of these systems has been unclear in the literature.

Methods: Patients undergoing one-level to three-level PLF (with or without anterior or posterior interbody fusion) were identified from the 2015 to 2022 M161Ortho PearlDiver Database using CPT codes. Navigation assistance was identified based on CPT coding and robotic assistance was based on ICD-10 procedural coding. Navigation-assisted cases were matched 4:1 to robotic-assisted patients based on age, sex, Elixhauser Comorbidity Index, number of levels fuse, and concomitant anterior fusion. Incidence of 90-day adverse outcomes were assessed and compared with multivariable logistical regression. Bonferroni correction was applied for multiple testing. Rate of reoperation was assessed using the Kaplan-Meier survival analysis.

Results: From 2015 to 2022, there has been a significant increase in both navigation-assisted and robotic-assisted lumbar fusions, with navigation-assisted surgery being significantly more common. After matching, there were 2401 navigation-assisted cases and 651 robotic-assisted cases. On multivariate analysis, there were no significant differences in 90-day any, severe, or minor adverse events. There was a significant increase odd of readmissions in the robotic cohort (OR: 1.77, P <0.001). There were no differences in 3-year reoperation rates between the navigation-assisted and robotic-assisted cohorts (95.8% vs. 94.0%, P =0.30).

Conclusions: As spinal navigation has been gaining popularity and robotic assistance is starting to be further utilized, the incremental advantage of different techniques may be questioned. While further study and technique evolution are ongoing, the current study was not able to demonstrate 90-day or 3-year incremental advantages for robotics relative to navigation based on the metrics evaluated.

Level of evidence: Level III.

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机器人与导航辅助后路腰椎融合术：全国数据库研究。

研究设计回顾性队列研究：比较导航辅助和机器人辅助后路腰椎融合术的围手术期不良事件和再手术情况：腰椎后路融合术（PLF）越来越多地采用导航技术。最近，机器人辅助系统越来越受到重视。然而，这些系统的增量优势在文献中并不明确：使用 CPT 代码从 2015-2022 年 M161Ortho PearlDiver 数据库中识别了接受一至三级 PLF（有或没有前路或后路椎体间融合术）的患者。导航辅助根据 CPT 编码确定，机器人辅助根据 ICD-10 程序编码确定。根据年龄、性别、Elixhauser 合并指数、融合层次数和同时进行的前路融合术，导航辅助病例与机器人辅助患者的匹配率为 4:1。评估了90天不良后果的发生率，并通过多变量逻辑回归进行了比较。多重检验采用 Bonferroni 校正。采用卡普兰-梅耶尔生存分析法评估再手术率：从2015年到2022年，导航和机器人辅助腰椎融合术都有显著增加，其中导航辅助手术明显更常见。匹配后，导航辅助病例为2401例，机器人辅助病例为651例。经多变量分析，90天内发生的任何、严重或轻微不良事件均无明显差异。机器人辅助组的再入院病例数明显增加（OR：1.77，PC结论）：随着脊柱导航的普及和机器人辅助技术的进一步应用，不同技术的增量优势可能会受到质疑。虽然进一步的研究和技术演变仍在进行中，但根据评估指标，目前的研究无法证明机器人技术相对于导航技术的 90 天或 3 年增量优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.