Robotic spine surgery compared with fluoroscopic-assisted surgery: advantages, disadvantages, future perspectives

Robotic spine surgery (RSS) could potentially overcome some limitations of fluoroscopic-assisted surgery (FAS). The aim of this study was to analyze RSS advantages compared to FAS and the impact of a dedicated nursing team on surgical workflow efficiency.

We retrospectively analyzed 260 adult patients with thoracolumbar degenerative/traumatic instability. One-hundred-thirty underwent posterior fusion with Medtronic Mazor X, while 130 were treated with FAS. Parameters included operative duration, OR entry-to-start time, screw implantation time, accuracy (Gertzbein-Robbins classification), radiation exposure, complications, and Oswestry Disability Index (ODI). We also assessed OR entry-start surgery/implant times, number of screws implanted, and duration of the intervention before and after the introduction of a dedicated nursing team for RSS.

RSS reduced implantation times with higher accuracy of pedicle screws. It decreased exposure to radiation for both surgeons and patients. In our case series, there were no significant differences in complications or hospitalization times. A 10% difference in means was observed to the most recent follow-up between ODI of the patients operated with robotic (5%) and fluoroscopic-assisted (15%) surgery. In the RSS group, three (2.3%) cases of junctional syndrome occurred, seventeen (13.1%) with FAS. Implementing a dedicated nursing team reduced OR entry-start time and overall duration of robotic procedures.

In our experience, RSS had important advantages compared to FAS in terms of accuracy of pedicle screw positioning. It reduced implantation times and postoperative pain without additional complications. The learning curve of the operating room staff represented a crucial point in the speed of execution of the procedure.