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What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients

Multicenter cohort. OBJECTIVE. To compare the robot time/screw, radiation exposure, robot abandonment, screw accuracy, and 90-day outcomes between robot-assisted percutaneous and robot-assisted open approach for short lumbar fusion (1- and 2-level). SUMMARY OF BACKGROUND DATA. There is conflicting l...

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Autores principales: Lee, Nathan J., Buchanan, Ian A., Zuckermann, Scott L., Boddapati, Venkat, Mathew, Justin, Geiselmann, Matthew, Park, Paul J., Leung, Eric, Buchholz, Avery L., Khan, Asham, Mullin, Jeffrey, Pollina, John, Jazini, Ehsan, Haines, Colin, Schuler, Thomas C., Good, Christopher R., Lombardi, Joseph M., Lehman, Ronald A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8654274/
https://www.ncbi.nlm.nih.gov/pubmed/34091564
http://dx.doi.org/10.1097/BRS.0000000000004132
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author Lee, Nathan J.
Buchanan, Ian A.
Zuckermann, Scott L.
Boddapati, Venkat
Mathew, Justin
Geiselmann, Matthew
Park, Paul J.
Leung, Eric
Buchholz, Avery L.
Khan, Asham
Mullin, Jeffrey
Pollina, John
Jazini, Ehsan
Haines, Colin
Schuler, Thomas C.
Good, Christopher R.
Lombardi, Joseph M.
Lehman, Ronald A.
author_facet Lee, Nathan J.
Buchanan, Ian A.
Zuckermann, Scott L.
Boddapati, Venkat
Mathew, Justin
Geiselmann, Matthew
Park, Paul J.
Leung, Eric
Buchholz, Avery L.
Khan, Asham
Mullin, Jeffrey
Pollina, John
Jazini, Ehsan
Haines, Colin
Schuler, Thomas C.
Good, Christopher R.
Lombardi, Joseph M.
Lehman, Ronald A.
author_sort Lee, Nathan J.
collection PubMed
description Multicenter cohort. OBJECTIVE. To compare the robot time/screw, radiation exposure, robot abandonment, screw accuracy, and 90-day outcomes between robot-assisted percutaneous and robot-assisted open approach for short lumbar fusion (1- and 2-level). SUMMARY OF BACKGROUND DATA. There is conflicting literature on the superiority of robot-assisted minimally invasive spine surgery to open techniques. A large, multicenter study is needed to further elucidate the outcomes and complications between these two approaches. METHODS. We included adult patients (≥18 yrs old) who underwent robot-assisted short lumbar fusion surgery from 2015 to 2019 at four independent institutions. A propensity score matching algorithm was employed to control for the potential selection bias between percutaneous and open surgery. The minimum follow-up was 90 days after the index surgery. RESULTS. After propensity score matching, 310 patients remained. The mean (standard deviation) Charlson comorbidity index was 1.6 (1.5) and 53% of patients were female. The most common diagnoses included high-grade spondylolisthesis (grade >2) (48%), degenerative disc disease (22%), and spinal stenosis (25%), and the mean number of instrumented levels was 1.5(0.5). The operative time was longer in the open (198 min) versus the percutaneous group (167 min, P value = 0.007). However, the robot time/screw was similar between cohorts (P value > 0.05). The fluoroscopy time/ screw for percutaneous (14.4 s) was longer than the open group (10.1 s, P value = 0.021). The rates for screw exchange and robot abandonment were similar between groups (P value > 0.05). The estimated blood loss (open: 146 mL vs. percutaneous: 61.3 mL, P value < 0.001) and transfusion rate (open: 3.9% vs. percutaneous: 0%, P value = 0.013) were greater for the open group. The 90-day complication rate and mean length of stay were not different between cohorts (P value > 0.05). CONCLUSION. Percutaneous robot-assisted spine surgery may increase radiation exposure, but can achieve a shorter operative time and lower risk for intraoperative blood loss for short-lumbar fusion. Percutaneous approaches do not appear to have an advantage for other short-term postoperative outcomes. Future multicenter studies on longer fusion surgeries and the inclusion of patient-reported outcomes are needed. Level of Evidence: 3
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spelling pubmed-86542742021-12-15 What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients Lee, Nathan J. Buchanan, Ian A. Zuckermann, Scott L. Boddapati, Venkat Mathew, Justin Geiselmann, Matthew Park, Paul J. Leung, Eric Buchholz, Avery L. Khan, Asham Mullin, Jeffrey Pollina, John Jazini, Ehsan Haines, Colin Schuler, Thomas C. Good, Christopher R. Lombardi, Joseph M. Lehman, Ronald A. Spine (Phila Pa 1976) Surgery Multicenter cohort. OBJECTIVE. To compare the robot time/screw, radiation exposure, robot abandonment, screw accuracy, and 90-day outcomes between robot-assisted percutaneous and robot-assisted open approach for short lumbar fusion (1- and 2-level). SUMMARY OF BACKGROUND DATA. There is conflicting literature on the superiority of robot-assisted minimally invasive spine surgery to open techniques. A large, multicenter study is needed to further elucidate the outcomes and complications between these two approaches. METHODS. We included adult patients (≥18 yrs old) who underwent robot-assisted short lumbar fusion surgery from 2015 to 2019 at four independent institutions. A propensity score matching algorithm was employed to control for the potential selection bias between percutaneous and open surgery. The minimum follow-up was 90 days after the index surgery. RESULTS. After propensity score matching, 310 patients remained. The mean (standard deviation) Charlson comorbidity index was 1.6 (1.5) and 53% of patients were female. The most common diagnoses included high-grade spondylolisthesis (grade >2) (48%), degenerative disc disease (22%), and spinal stenosis (25%), and the mean number of instrumented levels was 1.5(0.5). The operative time was longer in the open (198 min) versus the percutaneous group (167 min, P value = 0.007). However, the robot time/screw was similar between cohorts (P value > 0.05). The fluoroscopy time/ screw for percutaneous (14.4 s) was longer than the open group (10.1 s, P value = 0.021). The rates for screw exchange and robot abandonment were similar between groups (P value > 0.05). The estimated blood loss (open: 146 mL vs. percutaneous: 61.3 mL, P value < 0.001) and transfusion rate (open: 3.9% vs. percutaneous: 0%, P value = 0.013) were greater for the open group. The 90-day complication rate and mean length of stay were not different between cohorts (P value > 0.05). CONCLUSION. Percutaneous robot-assisted spine surgery may increase radiation exposure, but can achieve a shorter operative time and lower risk for intraoperative blood loss for short-lumbar fusion. Percutaneous approaches do not appear to have an advantage for other short-term postoperative outcomes. Future multicenter studies on longer fusion surgeries and the inclusion of patient-reported outcomes are needed. Level of Evidence: 3 Lippincott Williams & Wilkins 2022-01-01 2021-06-04 /pmc/articles/PMC8654274/ /pubmed/34091564 http://dx.doi.org/10.1097/BRS.0000000000004132 Text en Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Surgery
Lee, Nathan J.
Buchanan, Ian A.
Zuckermann, Scott L.
Boddapati, Venkat
Mathew, Justin
Geiselmann, Matthew
Park, Paul J.
Leung, Eric
Buchholz, Avery L.
Khan, Asham
Mullin, Jeffrey
Pollina, John
Jazini, Ehsan
Haines, Colin
Schuler, Thomas C.
Good, Christopher R.
Lombardi, Joseph M.
Lehman, Ronald A.
What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients
title What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients
title_full What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients
title_fullStr What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients
title_full_unstemmed What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients
title_short What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?: A Multicenter, Propensity-Matched Analysis of 310 Patients
title_sort what is the comparison in robot time per screw, radiation exposure, robot abandonment, screw accuracy, and clinical outcomes between percutaneous and open robot-assisted short lumbar fusion?: a multicenter, propensity-matched analysis of 310 patients
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8654274/
https://www.ncbi.nlm.nih.gov/pubmed/34091564
http://dx.doi.org/10.1097/BRS.0000000000004132
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