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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Minimally invasive, robotic- vs. open fluoroscopic-guided spinal instrumented fusions – a randomized, controlled trial

Meeting Abstract

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  • Seung-Jae Hyun - Seoul National University Bundang Hospital, Seoul National University College of Medicine
  • Ki-Jeong Kim - Seoul National University Bundang Hospital, Seoul National University College of Medicine
  • Tae-Ahn Jahng - Seoul National University Bundang Hospital, Seoul National University College of Medicine
  • Hyun-Jib Kim - Seoul National University Bundang Hospital, Seoul National University College of Medicine

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.19.03

doi: 10.3205/16dgnc214, urn:nbn:de:0183-16dgnc2140

Published: June 8, 2016

© 2016 Hyun et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Minimally-invasive spine surgery (MIS) requires a protracted learning curve and excessively exposes the patient and surgical team to harmful radiation. Robotic-guidance has been shown to improve accuracy and radiation in most studies, but there is conflicting prospective data. To compare the impact of robotic guidance in a minimally invasive approach to a fluoroscopy-guided, open approach, in lumbar fusions.

Method: This single-center, prospective, randomized (1:1) study, recruited adult patients with single- or double-level degenerative lumbar disorders scheduled to undergo primary lumbar interbody fusion during the period of December 2013 to January 2015. Patients were randomly allocated, using blinded randomization blocks, between robot-guided surgery in a minimally invasive approach, and traditional open surgery, with fluoroscopy assistance. The study is registered on CRiS (WHO) as KCT0000993. The local ethical committee approved this study. (IRB No.: B-1311/228-008)

Results: Thirty patients were recruited to each arm. Average age was 66.7, 71.5% were females, average BMI was 25.2. Thirty-five levels were instrumented with 130 pedicle screws in RO vs. 40 levels with 140 screws in FA, or 4.3 and 4.7 screws per surgery, respectively. Operative time was 208.5 minutes in both groups. Use of fluoroscopy was 3.5 vs. 13.3 seconds in the RO and FA respectively (p<0.001). C-arm output in mSv was 0.13 vs. 0.27 in the RO and FA respectively (p=0.015). There was no difference in the improvement in VAS scores for back and leg or the ODI. All screws were accurate in RO while 2 breached (>2mm and >4mm) in FA (p=0.500). One proximal facet violation occurred in the study, it was in FA (p=1.000). The average distance from the proximal facets was 5.8 vs. 4.6 in the RO and FA respectively (p<0.001). The average length of stay was 6.8 vs. 9.4 in RO compared with FA (p=0.020).

Conclusions: Robotic-guidance significantly reduced radiation exposure and length of stay. Patient outcomes were not affected by the surgical technique.