Operative Efficiency Among Robotic-, Navigation-, and Fluoroscopy-Assisted Systems in 1- and 2-Level Open Transforaminal Lumbar Interbody Fusion

Background: Navigation-assisted (NA) and robotic-assisted (RA) systems are being employed as guidance systems over traditional fluoroscopy-assisted (FA) systems to enhance surgical accuracy and safety. These systems allow surgeons to plan screw trajectories based on patient-specific anatomy and obtain real-time tracking of navigated instruments. This study sought to analyze procedural efficiency and outcomes with these systems. Methods: A retrospective chart review was conducted for patients who underwent 1- or 2-level open transforaminal lumbar interbody fusion (TLIF) as a primary procedure by a single surgeon from 2014 to 2024. Patients needed to be ≥18 years, diagnosed with lumbar degenerative or deformity conditions. Operative time (OT) (skin to closure) in minutes, length of stay (LOS) in days, estimated blood loss (EBL) in mL, and fluoroscopy time (FT) in seconds were analyzed. Results: The study included 170 patients operated at 1-level (118, 20, and 32 cases for FA, NA, and RA systems, respectively) and 74 patients operated at 2-levels (44, nine, and 21 cases for FA, NA, and RA systems, respectively). There was no significant difference in operative efficiency (OT, LOS, EBL, FT) between NA and RA in both 1- and 2-level procedures. The RA group showed significantly less OT, EBL, and LOS than the FA group for both 1- and 2-level procedures. When looking at a narrow transitional period of robotic adoption, OT and LOS were not markedly different between the first 9-10 RA cases and the last 9-10 NA cases. Conclusion: In both 1- and 2-level open TLIF procedures, the NA and RA systems showed similar outcomes to each other and statistically significant improvements in OT and EBL compared to the FA system. An experienced NA system user transitioning to a RA system did not experience reductions in operative efficiency.