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Updated: Jun 6, 2025
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Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
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Comparison between robot-assisted and navigation-guided minimally invasive transforaminal lumbar interbody fusion: a
Dennis Chen Heath1,2, Hsuan-Kan Chang3,4, Chih-Chang Chang3,5
11Department of Neurosurgery, Shuang-Ho Hospital, Taipei Medical University, New Taipei City.
Neurosurgical Focus
|December 1, 2024
Summary
Robot-assisted surgery achieved superior screw accuracy in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) compared to navigation-guided techniques. Both methods demonstrated high safety, with no revision surgeries needed for screw malposition.
Area of Science:
- Spine Surgery
- Minimally Invasive Spine Surgery
- Surgical Navigation Technologies
Background:
- Percutaneous pedicle screw placement accuracy and safety are enhanced by robot and computer navigation over freehand fluoroscopy.
- Direct comparative data between robot-assisted and navigation-guided techniques for percutaneous pedicle screw placement in MIS-TLIF is lacking.
Purpose of the Study:
- To compare the accuracy and safety of robot-assisted versus navigation-guided percutaneous pedicle screw placement.
- To evaluate these technologies within the context of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
Main Methods:
- A multicenter, retrospective study analyzed 100 patients undergoing 1- to 3-level MIS-TLIF between 2019 and 2022.
- Patients were divided into robot-assisted (RA) and O-arm navigation (ON) groups.
- Postoperative CT scans assessed screw accuracy using the Gertzbein and Robbins classification; safety outcomes included medial breaches and revision surgeries.
Main Results:
- Robot-assisted surgery achieved 100% clinically satisfactory screw accuracy, significantly higher than the 92.1% in the navigation group (p < 0.001).
- No medial breaches or revision surgeries for screw malposition occurred in either group.
- Overall operation time was similar, but robot-assisted surgery took longer for 2-level MIS-TLIF procedures (p = 0.0264).
Conclusions:
- Robot-assisted percutaneous pedicle screw placement demonstrates superior accuracy compared to navigation-guided techniques in MIS-TLIF.
- Both methods offer comparable safety profiles, with no instances of revision surgery for malposition.
- While overall operative time is similar, robot-assisted surgery may increase duration for multi-level fusions.
