Introduction: Navigation (N) and robotic (R) systems are being employed as guidance systems over traditional fluoroscopy (F) to enhance surgical accuracy and safety while performing transforaminal lumbar interbody fusion procedures (TLIF). However, it is unclear if these new systems compromise operational efficiency enabled by the well-established fluoroscopic guided systems, so this study aims to analyze those outcomes.
Methods: This is a retrospective chart review of all patients who underwent 1-level open 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, and have >4 weeks postoperative data. Operative time in minutes (OT), hospital stay in days (HS), blood loss in mL (BL), and fluoroscopy time in seconds (FT) were analyzed in this study.
Results: The 1-level group included 170 patients across the F, N, and R systems (118, 20, and 32 cases, respectively). The results show that there was no statistical difference in mean OT, HS, and BL between N and R systems (all p>0.05), whereas all were statistically significant between F and N systems as well as F and R systems (all p< 0.05) (OT: F=138.0±44.3, N=113.0±29.2, and R=103.0±44.3 minutes; HS: F=2.3±1.2, N=0.8±1.0, and R=0.8±1.1 days; BL: F=392.0±290.0, N=158.0±112.0, and R=177.0±102.0 mL). Regarding FT, there was a statistical difference between F and N systems (p < 0.05), but no significant difference between F and R or between N and R systems (F=35.3±42.6 (n=115), N=63.0±68.9 (n=20), and R=28.6±13.5 (n=27) seconds).
Conclusion : In the 1-level group, the R system demonstrated outcomes comparable to the N system and significantly outperformed the F system in terms of OT, HS, and BL, reinforcing the operational efficiency of the R system.