Comparative cost-effectiveness analysis between navigated robot-assisted platforms and O-arm navigation in minimally invasive transforaminal interbody fusion (MIS-TLIF).

BACKGROUND CONTEXT: Minimally invasive transforaminal lumbar interbody fusion (TLIF) is an increasingly common procedure used in treating degenerative lumbar spine conditions. Advancement of robot-assisted technology has improved accuracy of instrumentation with smaller incisions, resulting in better surgical outcomes and shorter hospital stay.

PURPOSE: This study aims to assess cost effectiveness of robot-assisted minimally invasive TLIF (RA-TLIF) in our institution; and compare patient outcomes with conventional O-arm navigated minimally invasive TLIF (ON-TLIF).

DESIGN

Single-center, retrospective case cohort series between elective RA-TLIF and ON-TLIF groups.

PATIENT SAMPLE: About 27 patients who underwent elective RA-TLIF and control group of 50 elective ON-TLIF.

OUTCOME MEASURES: Operative duration, length of inpatient stay, postoperative ambulation, rates of intraoperative and postoperative complications and inpatient costs.

METHODS

Patient demographics (age, gender, Charlson Comorbidity Index (CCI), BMI), postoperative outcomes and inpatient costs were used in comparative analysis.

RESULTS

No significant differences were found in patient demographics, baseline CCI, operative duration, length of inpatient stay, and postoperative ambulation. Rates of intraoperative and postoperative complications were similar between the 2 groups (OR=0.93, p=.112). Inpatient hospitalization costs were not significantly different between both groups.

CONCLUSION

RA-TLIF has shown similar cost-effectiveness and surgical outcomes in comparison with conventional ON-TLIF. While not demonstrated in this study, RA-TLIF has been associated with a longer operative duration due to higher learning curve, set-up time and possible hardware/software errors. Ultimately, more case numbers are required for the operating staff to overcome this learning curve to achieve optimal results. Spine surgical centers evaluating both techniques may consider either with confidence.