200. Comparison of freehand, fluoro-guided, CT navigation, and robot-guided TLIF and ALIF

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BACKGROUND CONTEXT

Screw placement in transforaminal interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) can be done with open free hand (FH), fluoroscopy-guided (FG), spinal navigation (NAV), or robotic guided (RG) techniques. Varied techniques may affect perioperative (periop) outcomes. Few studies compare all four guidance techniques.

PURPOSE

Compare the perioperative outcomes between FH, FG, NAV, and RG TLIF and ALIF.

STUDY DESIGN/SETTING

Single center retrospective cohort study

PATIENT SAMPLE

A total of 1,646 patients who underwent 1-2 level TLIF or 1-3 level ALIF from 2012-2019.

OUTCOME MEASURES

Outcomes: registration failure, operative time (OT), radiation dosage (RD), estimated blood loss (EBL), length of stay (LOS), and periop complications, and retursn to OR up to 90 days.

METHODS

Patients undergoing 1-2 level TLIF or 1-3 level ALIF were included. Analysis of variance (ANOVA) and χ2test were used to analyze differences in outcomes with significance set at p<0.05. Post hoc Tukey (PHT) and Bonferroni (PHB) analysis were conducted when ANOVA or χ2 showed significance. RD was propensity matched for BMI. TLIFs underwent PSM for levels fused.

RESULTS

A total of 1,202 1-2 level TLIFs were included (843 FH, 175 FG, 40 NAV, 144 RG) TLIFS. 444 1-3 level ALIFs were included: 337 FH, 25 FG, and 80 RG ALIFs. Demographics were similar amongst ALIF cohorts except significantly more FH-ALIF smokers and TLIF cohorts after propensity matching for levels fused. Amongst the TLIF Cohorts: OT and LOS longest in NAV (291.67±89.85 min; p <0.001 and 5.38±1.66 days p<0.001); EBL most in FG (482.43±530.79mL p=0.006). After PSM for BMI, there was no significant difference in RD. RG TLIF registration failed in 2.8% of cases. There were significantly more intraop (11.1%, p=0.008), and postop (45.8%; p<0.001) complications in the RG cohort, which showed high durotomy rates (6.9%; p=0.05) and instrumentation failure rates approaching significance (3.5%; p=0.058). The NAV group had the highest rate of SSI (2.5%; p = 0.045). Among the ALIF cohorts: RD, EBL, and LOS were similar; OT was longest in FG (395.7±113.7 p=0.001). There were significantly more intra- and postop complications in RG group (26.3%, p<0.001; 30%, p<0.001) and 13.8% of RG failed registration. Instrumentation failure was highest in FG (4.0% p=0.676), along with return to OR for instrumentation (8%, p = 0.183). Other periop complications and returns to OR were not significantly different.

CONCLUSIONS

NAV-TLIF had significantly differences in EBL, RD, periop complications, and return to OR 30 days. PSM for levels fused show postop complications rate remain significant with other factors and radiographic dosage remaining significant. RG TLIF and RG ALIF had the worst perioperative complications.

FDA DEVICE/DRUG STATUS

This abstract does not discuss or include any applicable devices or drugs.

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