Michael J Gouzoulis, Anthony E Seddio, Adam D Winter, Sahir S Jabbouri, Justin R Zhu, Daniel R Rubio, Arya G Varthi, Jonathan N Grauer
{"title":"机器人与导航辅助后路腰椎融合术：全国数据库研究。","authors":"Michael J Gouzoulis, Anthony E Seddio, Adam D Winter, Sahir S Jabbouri, Justin R Zhu, Daniel R Rubio, Arya G Varthi, Jonathan N Grauer","doi":"10.1097/BRS.0000000000005032","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The aim of this study was to compare perioperative adverse events and reoperations between navigation-assisted and robotic-assisted posterior lumbar fusion.</p><p><strong>Summary of background data: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"1483-1487"},"PeriodicalIF":2.6000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Robotic-Assisted Versus Navigation-Assisted Posterior Lumbar Fusion : A National Database Study.\",\"authors\":\"Michael J Gouzoulis, Anthony E Seddio, Adam D Winter, Sahir S Jabbouri, Justin R Zhu, Daniel R Rubio, Arya G Varthi, Jonathan N Grauer\",\"doi\":\"10.1097/BRS.0000000000005032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The aim of this study was to compare perioperative adverse events and reoperations between navigation-assisted and robotic-assisted posterior lumbar fusion.</p><p><strong>Summary of background data: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"1483-1487\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005032\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/5/8 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005032","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/8 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Robotic-Assisted Versus Navigation-Assisted Posterior Lumbar Fusion : A National Database Study.
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.
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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.
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