gms | German Medical Science

Objective: We tested the hypothesis that percutaneous stab incisions in the robot-assisted group are advantageous over the long midline incision used for exposure in the conventional approach.

Method: Patients operated for pyogenic spondylodiscitis between 2007 to 2014 were included in the analysis. Surgery was performed either openly using conventional technique, i.e. anatomical exposure of entry points under lateral fluoroscopic guidance or a robot-assisted percutaneous approach. We retrieved the variables age, surgical technique, presence of diabetes, osteoporosis, renal failure, peripheral vascular disease and colonization with methicillin-resistant staphylococcus aureus (MRSA).

Results: A total of 201 patients underwent surgery for spondylodiscitis. Data on the surgical technique were available for 190 cases, 118 (62.1%) of which underwent open and 72 of which (37.9%) underwent robot-guided instrumentation. Wound healing problems occurred in 44/193 patients (21.4%). Wound healing affected 11/72 patients (15.3%) in the robot group and 32/118 (27.1%) in the conventional surgery group (Chi2, p=0.07). Obesity (BMI>30) was associated with wound healing problems (p=0.007), while instrumentation of more than one segment (p=0.47), age (p=0.23), renal failure (p=1.00), diabetes (p=0.46), peripheral vascular disease (p=0.69), osteoporosis (p=0.08), >1 segment surgery (p=0.007), colonization with MRSA (p=1.00) were not identified as significant contributors.

Conclusions: Our data suggest that when performing instrumentation in patients with pyogenic spondylodiscitis, percutaneous robot-guided surgery is associated with a reduced rate of wound infections. The rationale of minimizing the extent of the skin incision with the aid of auxiliary techniques such as robotic surgery may therefore prove an important factor in reducing overall morbidity of this fragile patient population. Furthermore, obesity was identified as a strong predictor of wound healing problems.