{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:45:47Z","timestamp":1784004347425,"version":"3.55.0"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Robot-assisted (RA) technology is becoming more widely integrated and accepted in spine surgery. The authors sought to evaluate operative and patient-reported outcomes (PROs) in RA versus fluoroscopy-assisted (FA) pedicle screw placement during minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors retrospectively studied elective patients who underwent single- or multilevel MIS TLIF for degenerative indication using FA versus RA pedicle screw placement. Patients were selected from September 2021 to May 2023 at a single institution with multiple surgeons whose practice consists of primarily MIS. Outcomes included fluoroscopy dosage per screw, operative time per screw, anesthesia time per screw, estimated blood loss (EBL), screw revision rate, inpatient surgical complications, and minimal clinically important difference (MCID) of Oswestry Disability Index (ODI) and numeric rating scale (NRS) scores at the 6- and 12-month follow-ups. Comparability of groups was analyzed by univariate analysis. Multivariable analysis modeling fluoroscopy time per screw was performed, adjusting for confounders.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n One hundred eighty-three patients (n = 133 in the FA group vs 50 in the RA group) were included. Patients in the RA cohort were significantly younger than those in the FA group (mean age 63.8 \u00b1 11.9 vs 59.8 \u00b1 11.0 years, p = 0.037). A total of 932 pedicle screws were placed (mean 5.1, range 4\u20138 per patient). The RA cohort demonstrated significantly lower intraoperative fluoroscopy dosage per screw (4.9 \u00b1 7.6 mGy per screw vs 20.3 \u00b1 14.0 mGy per screw, p < 0.001), significantly longer anesthesia time per screw (49.1 \u00b1 12.6 vs 43.6 \u00b1 9.2, p = 0.009), and similar operative time per screw (33.3 vs 30.7 minutes, p = 0.125). The screw revision rate for symptomatic radiculopathy was zero in both groups. Revision surgery requiring screw removal or reposition was performed in 4 total cases (RA group: 1\/50 for infection; FA group: 2\/133 for infection, 1\/133 for foraminotomy). Both groups demonstrated significant improvement in PROs at 6 and 12 months compared with preoperatively. Moreover, both groups achieved MCID at similar rates.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n When implementing RA technology, one can expect similar perioperative outcomes as FA techniques in addition to significantly lower radiation exposure. Moreover, there is no statistically significant difference in postoperative PROs between RA and FA. Longer anesthesia times may also be encountered, as in this study, which is likely a result of more complex robotic setup and workflow.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.9.focus24489","type":"journal-article","created":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T08:25:04Z","timestamp":1733041504000},"page":"E11","source":"Crossref","is-referenced-by-count":8,"title":["Irradiation safety, anesthesia time, surgical complications, and patient-reported outcomes in the robotic Mazor X versus fluoroscopy guided minimally invasive transforaminal lumbar interbody fusion surgery: a comparative cohort study"],"prefix":"10.3171","volume":"57","author":[{"given":"Daniel W.","family":"Griepp","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Caskey","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Bunjaj","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Lake Erie College of Medicine, Erie, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Turnbull","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammar","family":"Alsalahi","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hepzibha","family":"Alexander","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Dragonette","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryce","family":"Sarcar","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivum","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doris","family":"Tong","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teck M.","family":"Soo","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Bono","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Kelkar","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford","family":"Houseman","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad F.","family":"Claus","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyd F.","family":"Richards","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Carr","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Henry Ford Providence Hospital, Southfield, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Eur Spine J","first-page":"1017","article-title":"Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis","volume":"24","author":"Phan K","year":"2015","unstructured":"Phan K, Rao PJ, Kam AC, Mobbs RJ. Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Eur Spine J. 2015;24(5):1017\u20131030."},{"issue":"5","key":"b2","series-title":"J Neurosurg Sci","first-page":"391","article-title":"The evolving neurosurgical perspective on Enhanced Recovery After Surgery (ERAS): a systematic review","volume":"66","author":"Fiani B","year":"2022","unstructured":"Fiani B, Griepp DW, Kurien L, The evolving neurosurgical perspective on Enhanced Recovery After Surgery (ERAS): a systematic review. J Neurosurg Sci. 2022;66(5):391\u2013398."},{"issue":"5","key":"b3","series-title":"J Neurosurg Spine","first-page":"503","article-title":"Quantitative analysis of misplaced pedicle screws in the thoracic spine: how much pullout strength is lost? 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Spine J. 2021;21(2):193\u2013201."},{"key":"b5","series-title":"World Neurosurg","first-page":"e570","article-title":"Perioperative comparison of robotic-assisted versus fluoroscopically guided minimally invasive transforaminal lumbar interbody fusion","volume":"149","author":"De Biase G","year":"2021","unstructured":"De Biase G, Gassie K, Garcia D, Perioperative comparison of robotic-assisted versus fluoroscopically guided minimally invasive transforaminal lumbar interbody fusion. World Neurosurg. 2021;149:e570\u2013e575."},{"issue":"5","key":"b6","series-title":"Global Spine J","first-page":"1464","article-title":"Comparison of safety and perioperative outcomes between patient-specific template-guided and fluoroscopic-assisted freehand lumbar screw placement using cortical bone trajectory technique","volume":"14","author":"Matsukawa K","year":"2024","unstructured":"Matsukawa K, Kaito T, Abe Y. Comparison of safety and perioperative outcomes between patient-specific template-guided and fluoroscopic-assisted freehand lumbar screw placement using cortical bone trajectory technique. Global Spine J. 2024;14(5):1464\u20131471."},{"issue":"2","key":"b7","series-title":"Int J Med Robot","first-page":"e2188","article-title":"Fluoroscopy time analysis of a prospective, multi-centre study comparing robotic- and fluoroscopic-guided placement of percutaneous pedicle screw instrumentation for short segment minimally invasive lumbar fusion surgery","volume":"17","author":"Jamshidi AM","year":"2021","unstructured":"Jamshidi AM, Massel DH, Liounakos JI, Fluoroscopy time analysis of a prospective, multi-centre study comparing robotic- and fluoroscopic-guided placement of percutaneous pedicle screw instrumentation for short segment minimally invasive lumbar fusion surgery. 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Neurosurgery. 2012;71(2):N20\u2013N21."},{"issue":"1","key":"b10","series-title":"Syst Rev","first-page":"170","article-title":"Comparison of robot-assisted versus fluoroscopy-guided transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases: a systematic review and meta-analysis of randomized controlled trails and cohort studies","volume":"13","author":"Guan J","year":"2024","unstructured":"Guan J, Feng N, Yu X, Yang K. Comparison of robot-assisted versus fluoroscopy-guided transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases: a systematic review and meta-analysis of randomized controlled trails and cohort studies. 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Clin Neurol Neurosurg. 2021;206:106698."},{"issue":"1","key":"b26","series-title":"Oper Neurosurg (Hagerstown)","first-page":"61","article-title":"Next-generation robotic spine surgery: first report on feasibility, safety, and learning curve","volume":"17","author":"Khan A","year":"2019","unstructured":"Khan A, Meyers JE, Siasios I, Pollina J. Next-generation robotic spine surgery: first report on feasibility, safety, and learning curve. Oper Neurosurg (Hagerstown). 2019;17(1):61\u201369."},{"issue":"21","key":"b27","series-title":"Spine (Phila Pa 1976)","first-page":"1517","article-title":"Surgeon experience influences robotics learning curve for minimally invasive lumbar fusion: a cumulative sum analysis","volume":"48","author":"Shahi P","year":"2023","unstructured":"Shahi P, Subramanian T, Maayan O, Surgeon experience influences robotics learning curve for minimally invasive lumbar fusion: a cumulative sum analysis. 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World Neurosurg. 2019;130:e417\u2013e422."},{"issue":"7","key":"b32","series-title":"Global Spine J","first-page":"1871","article-title":"Clinical outcomes of robotic versus freehand pedicle screw placement after one-to three-level lumbar fusion","volume":"13","author":"Karamian BA","year":"2023","unstructured":"Karamian BA, DiMaria SL, Sawires AN, Clinical outcomes of robotic versus freehand pedicle screw placement after one-to three-level lumbar fusion. Global Spine J. 2023;13(7):1871\u20131877."},{"issue":"3","key":"b33","series-title":"Yonsei Med J","first-page":"438","article-title":"Radiographic and clinical outcomes of robot-assisted posterior pedicle screw fixation: two-year results from a randomized controlled trial","volume":"59","author":"Park SM","year":"2018","unstructured":"Park SM, Kim HJ, Lee SY, Chang BS, Lee CK, Yeom JS. Radiographic and clinical outcomes of robot-assisted posterior pedicle screw fixation: two-year results from a randomized controlled trial. 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Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Eur Spine J. 2015;24(5):1017\u20131030."},{"issue":"5","key":"b2","series-title":"J Neurosurg Sci","first-page":"391","article-title":"The evolving neurosurgical perspective on Enhanced Recovery After Surgery (ERAS): a systematic review","volume":"66","author":"Fiani B","year":"2022","unstructured":"Fiani B, Griepp DW, Kurien L, The evolving neurosurgical perspective on Enhanced Recovery After Surgery (ERAS): a systematic review. J Neurosurg Sci. 2022;66(5):391\u2013398."},{"issue":"5","key":"b3","series-title":"J Neurosurg Spine","first-page":"503","article-title":"Quantitative analysis of misplaced pedicle screws in the thoracic spine: how much pullout strength is lost? 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Comparison of safety and perioperative outcomes between patient-specific template-guided and fluoroscopic-assisted freehand lumbar screw placement using cortical bone trajectory technique. Global Spine J. 2024;14(5):1464\u20131471."},{"issue":"2","key":"b7","series-title":"Int J Med Robot","first-page":"e2188","article-title":"Fluoroscopy time analysis of a prospective, multi-centre study comparing robotic- and fluoroscopic-guided placement of percutaneous pedicle screw instrumentation for short segment minimally invasive lumbar fusion surgery","volume":"17","author":"Jamshidi AM","year":"2021","unstructured":"Jamshidi AM, Massel DH, Liounakos JI, Fluoroscopy time analysis of a prospective, multi-centre study comparing robotic- and fluoroscopic-guided placement of percutaneous pedicle screw instrumentation for short segment minimally invasive lumbar fusion surgery. 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