Study design:
Retrospective cohort.
Objective:
To compare navigation and robotics in terms of clinical outcomes following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
Summary of background data:
While robotics has been shown to have advantages like reduced radiation exposure, greater screw size, and slightly better accuracy over navigation, none of the studies has compared these two modalities in terms of clinical outcomes.
Methods:
Patients who underwent single-level MI-TLIF using robotics or navigation and had a minimum of 1-year follow-up were included. The robotics and navigation groups were compared for improvement in patient reported outcome measures (PROMs), minimal clinically important difference (MCID), patient acceptable symptom state (PASS), response on global rating change (GRC) scale, and screw-related complication and reoperation rates.
Results:
278 patients (143 robotics, 135 navigation) were included. There was no significant difference between the robotics and navigation groups in the baseline demographics, operative variables, and preoperative PROMs. Both groups showed significant improvement in PROMs at <6 and >6 months with no significant difference in the magnitude of improvement between the two groups. Most patients achieved MCID and PASS and reported feeling better on the GRC scale with no significant difference in the proportions between the robotics and navigation groups. The screw-related complication and reoperation rates also showed no significant difference between the two groups.
Conclusion:
Robotics did not seem to lead to significantly better clinical outcomes compared to navigation following MI-TLIF. While the clinical outcomes may be similar, robotics offers the advantages of reduced radiation exposure, greater screw size, and slightly better accuracy over navigation. These advantages should be considered when determining the utility and cost-effectiveness of robotics in spine surgery. Larger multicenter prospective studies are required in future to further investigate this subject.
Level of evidence:
3.