Utilisation of table-mounted versus floor-mounted robotic systems for thoracolumbar fusion: a before-and-after institutional experience.

Robot-assisted spinal fusion is increasingly prevalent, with floor-mounted and table-mounted systems available. Direct comparative data are limited, particularly regarding institutional adoption and utilization.This IRB-approved retrospective study analyzed a before-and-after institutional experience of 601 navigated thoracolumbar fusions at Changi General Hospital from May 2022 to April 2025. Cases were grouped by the system available during consecutive periods: table-mounted (May 2022-October 2023) or floor-mounted (November 2023 onwards). Demographic variables, operative time per fused level, utilization rates, case context (elective vs. emergency), surgeon adoption, and a Revenue-to-Asset Cost Ratio analysis were evaluated.Among 601 fusions (294 during the table-mounted period; 307 during the floor-mounted period), robotic utilization was significantly higher with the floor-mounted system (52.0% vs. 9.2%, p < 0.0001). The floor-mounted system was employed in emergencies (63/159 cases; 39.6%), whereas the table-mounted system was restricted to elective procedures (0/27 cases; 0%) (p < 0.001). The floor-mounted system handled broader case complexity (p < 0.001) and saw increased surgeon adoption (100% vs. 33%, p = 0.015), though all surgeons received formal training in the latter period. Standardizing for construct complexity, the median operative time per level was significantly shorter for the floor-mounted system compared to the table-mounted system (125.0 vs. 190.0 min; p < 0.001). Total Revenue-to-Asset Cost Ratio was 145.16% vs. 74.39%.Both platform offer distinct benefits, though outcomes depend on surgeon proficiency. The floor-mounted system demonstrated superior versatility - wider surgeon adoption, emergency applicability, concurrent use, and better financial returns, providing practical considerations for hospitals evaluating spinal robotics investments.