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Updated: Jun 20, 2026
Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
Robotic assistance in posterolateral lumbar fusion is associated with higher comorbidity burden, greater 90-day
Mitchell K Ng1, Paul G Mastrokostas2, Anton J Cristofoli3
1Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Background Context:
Navigation and robotic assistance are increasingly used during posterolateral lumbar fusion (PLF), yet comparative associations with early wound/infectious complications and short-term costs remain incompletely characterized in large claims-based cohorts.
Purpose:
To compare patient characteristics, 90-day wound/infectious complications, and 90-day episode-of-care costs among conventional, navigation-assisted, and robot-assisted PLF (with and without interbody fusion).
Study Design/Setting:
Retrospective cohort study using a national administrative claims database (PearlDiver Mariner), 2016-2023.
Patient Sample:
Adult patients undergoing PLF, stratified by PLF without interbody fusion and PLF with interbody fusion.
Outcome Measures:
A 90-day postoperative superficial surgical site infection (SSI), deep SSI, organ/space SSI, wound dehiscence, and 90-day episode-of-care costs.
Methods:
The PearlDiver Mariner database was queried to identify adult PLF cases performed conventionally, with navigation assistance, or with robotic assistance. Outcomes were assessed at 90 days. Multivariable logistic regression was performed for complications. Statistical significance was set at p<.05.
Results:
We identified 305,313 PLF cases (150,293 without interbody; 155,020 with interbody). In PLF without interbody (ref=conventional), robot assistance increased odds of superficial SSI (OR 1.53, p<.001). Navigation increased odds of superficial SSI (OR 1.32, p<.001), deep SSI (OR 1.23, p<.001), and wound dehiscence (OR 1.09, p=.005). In PLF with interbody, robot assistance increased odds of organ/space SSI (OR 2.22, p=.002), and navigation increased odds of superficial SSI (OR 1.21, p<.001), deep SSI (OR 1.15, p=.019), organ/space SSI (OR 1.66, p<.001), and wound dehiscence (OR 1.07, p=.033). Mean 90-day costs were highest with robotics ($67,400 no-interbody; $65,200 interbody) versus navigation ($58,700; $56,300) and conventional ($53,700; $51,800; p≤0.05 for all).
Conclusions:
Technology-assisted PLF cohorts demonstrated higher comorbidity burden, greater 90-day infectious/wound complication rates, and higher costs than conventional PLF cohorts. This association should be interpreted in the context of greater baseline complexity and potential learning-curve effects in technology-assisted cohorts.