Outcomes of Robotic-Assisted Lumbar Fusions on an Outpatient Basis: A Retrospective Review

Introduction: With the advent of minimally invasive surgery (MIS) and the rise of robotic-assisted techniques, patient outcomes have significantly improved. Additionally, the introduction of outpatient surgical centers has lowered healthcare costs without compromising patient outcomes. Although these approaches have been proven effective in other surgical fields, their combined application in spine surgery remains under explored. This study aims to evaluate the feasibility and safety of integrating all three techniques in spine surgery.

Methods: Patients of a single neurosurgeon at Banner University Medical Center - Tucson who underwent outpatient, robotic assisted MIS lumbar fusion procedures with the Mazor X Stealth system between 2021 and 2023 were identified. The patients’ demographic data, comorbidities, surgical procedure, intraoperative complications, and 90-day postoperative medical complications were collected.

Results: 51 patients were included in the study. 90.2% underwent a transforaminal lumbar interbody fusion (TLIF), and 88.2% received single-level lumbar fusions. The most common indication for surgery was spinal stenosis (52.9%). The estimated average radiation exposure was 46.8 mGy for single-level fusions, 72.0 mGy for two-level fusions, and 64.9 mGy for three-level fusions. The average post-anesthesia care unit (PACU) time was 252.9 minutes. Intraoperatively, 9.8% of patients (n=5) experienced unintentional durotomies. In the PACU, 7.8% (n=4) experienced uncontrolled pain, 11.8% (n=6) urinary retention, and 7.8% (n=4) required admission directly after the PACU. Postoperatively, 3.9% (n=2) of patients experienced urinary retention, 2% (n=1) hypoxemia, 2% (n=1) residual pain, 2% (n=1) cardiac dysfunction, 2% (n=1) esophageal spasm, 3.9% (n=2) deep vein thrombosis (DVT), and 2% (n=1) experienced a fall. No new symptoms related to the surgical procedure were reported.

Conclusion : Robotic assisted MIS TLIF surgery may be viable on an outpatient basis without negatively impacting patient outcomes.