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Updated: Jun 10, 2026
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Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Operative Efficiency Among Robotic-, Navigation-, and Fluoroscopy-Assisted Systems in 1- and 2-Level Open
1Spine Surgery, Indiana University School of Medicine, Indianapolis, USA.
Cureus
|June 9, 2026
Summary
Navigation-assisted (NA) and robotic-assisted (RA) systems offer similar outcomes for lumbar fusion surgery, both outperforming traditional fluoroscopy-assisted (FA) methods. Transitioning from NA to RA systems does not decrease operative efficiency.
Area of Science:
- Spine Surgery
- Surgical Navigation Technologies
- Medical Device Innovation
Background:
- Traditional fluoroscopy-assisted (FA) systems are being supplemented by navigation-assisted (NA) and robotic-assisted (RA) guidance systems in spinal surgery.
- These advanced systems enable pre-operative planning of screw trajectories based on patient anatomy and real-time tracking of surgical instruments, aiming to improve accuracy and safety.
Purpose of the Study:
- To compare the procedural efficiency and clinical outcomes of navigation-assisted (NA) and robotic-assisted (RA) systems against traditional fluoroscopy-assisted (FA) systems.
- To analyze operative time, length of stay, estimated blood loss, and fluoroscopy time in patients undergoing open transforaminal lumbar interbody fusion (TLIF).
Main Methods:
- A retrospective chart review of 1- or 2-level open TLIF procedures performed between 2014 and 2024.
- Analysis included 170 patients for 1-level and 74 patients for 2-level fusions, comparing FA, NA, and RA systems.
- Key metrics analyzed were operative time (OT), length of stay (LOS), estimated blood loss (EBL), and fluoroscopy time (FT).
Main Results:
- No significant differences in operative efficiency (OT, LOS, EBL, FT) were observed between NA and RA systems for both 1- and 2-level procedures.
- Robotic-assisted (RA) systems demonstrated significantly reduced OT, EBL, and LOS compared to fluoroscopy-assisted (FA) systems in both 1- and 2-level TLIFs.
- During the transition period, operative time and length of stay were comparable between the initial robotic cases and the final navigation-assisted cases.
Conclusions:
- Both navigation-assisted (NA) and robotic-assisted (RA) systems provide comparable outcomes to each other and show statistically significant improvements in operative time and estimated blood loss over traditional fluoroscopy-assisted (FA) systems for open TLIF.
- Surgeons experienced with NA systems transitioning to RA systems did not experience a decrease in operative efficiency.
