2023 The Contribution of Intraoperative CT Integrated Directly With Robotic Navigation: Outcomes of the First 100 Consecutive Posterior Spinal Fusion Surgeries

INTRODUCTION: During robot-assisted spine surgery, the robotic navigation system is typically registered by obtaining intraoperative C-arm images which are then merged to a preoperative computed tomography (CT) scan. Recent technological advances permit direct registration with intraoperative CT with the patient already prone in the operative position. This has implications for improved accuracy and patient safety. METHODS: One hundred consecutive robot-assisted posterior spinal fusion surgeries performed with C-arm (Group 1) and intraoperative CT (Group 2) registration were retrospectively identified to serve as the control and experimental groups, respectively. The primary outcome was any complication within six months postoperatively which required additional surgery. Secondary outcomes were operative duration, intraoperative fluoroscopy time, estimated blood loss, and hospital length of stay. RESULTS: There were no statistically significant differences in the mean number of instrumented levels (5.07±2.73 vs. 4.46±2.99, p=0.133), mean number of screws placed (8.23±4.18 vs. 7.35±5.15 , p=0.186), or mean number of interbody fusions (0.67±0.73 vs. 0.66±0.070, p=0.921). Compared to Group 1, Group 2 had statistically fewer complications (4% vs. 13%, p=0.023), decreased operative duration (268±61 vs. 302±71 minutes, p=0.0005), decreased fluoroscopy time (40±21 vs. 53±28 seconds, p=0.014), decreased estimated blood loss (351±235 vs. 440±366 milliliters, p=0.019), and decreased hospital length of stay (4.0±2.0 vs. 4.8±3.1 days, p=0.026). CONCLUSIONS: In the present study, compared to standard C-arm registration, the use of intraoperative CT integrated directly with the robotic navigation system reduced the number of postoperative complications, and decreased the operative duration, fluoroscopy time, estimated blood loss, and hospital length of stay for patients undergoing robot-assisted posterior spinal fusion surgeries.