Robot-assisted versus fluoroscopy-guided pedicle screw placement in transforaminal lumbar interbody fusion for lumbar degenerative disease.

OBJECTIVE: To compare the clinical accuracy and perioperative outcomes for pedicle screw placement in transforaminal lumbar interbody fusion (TLIF) between robot-assisted (RA) technique and fluoroscopy-guided (FG) technique.

METHODS: 77 patients scheduled to undergo RA (43 patients) and FG (44 patients) TLIF surgery were included. Patient demographics, radiographic accuracy and perioperative outcomes were recorded and compared. The accuracy of pedicle screw placement was according to the Gertzbein and Robbins scale and facet joint violation. Perioperative outcome mainly included operative time, radiation exposure, and revisions.

RESULTS: Of the 176 screws in the RA group, 164 screws were grade A, and 9, 2 and 1 screws were grade B, C and D, respectively. Of the 204 screws in the FG group, 175 screws were grade A, with 16 screws scored as grade B, 8 screws grade C, 3 grade D, and 2 grade E. The rate of perfect screw position (grade A) was greater in the RA group than in FG (93.2% vs. 85.8%; P=0.020). 191 screws (93.6%) in FG group were clinically acceptable (group A + B), whereas more acceptable screw positions were achieved in RA (98.3%) (P=0.024). Less screws in the RA group violated the proximal facet joint (5 vs. 24 screws, P=0.001). The radiation dose was less in the RA group (25.9±14.2 vs. 70.5±27.3 μSv; P=0.000). 2 screws in FG required a revision, but no revision was required in RA.

CONCLUSION: RA pedicle screw placement is an accurate and safe procedure in TLIF for lumbar degenerative disease.