Commentary on “Robot-Guided Transforaminal Versus Robot-Guided Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease”

Abstract

Over the past 3 decades, minimally invasive spine surgery has gained world-wide popularity due to equivalent outcomes to open approaches with significant reductions in intraoperative blood loss, operative time, and hospital stays.1 The adaptation and evolution of image-guided stereotactic navigational technologies have resulted in the rapid transformation of minimally invasive spine surgical techniques.2,3 Utilization of navigation technologies for percutaneous pedicle screw insertion and interbody cage placement has allowed more efficient workflow and increased safety in minimally invasive spine surgical procedures.4,5 Recently, innovative robotic surgical systems have been introduced for spine surgery procedures as competitive or complementary tools to the use of spinal navigation.6,7 The advantages and feasibility of robotic-guided spine surgery have been well-established in the literature.6 However, robotic-guided spinal procedures have not been adapted widespread yet since the robotic devices require greater set-up time, additional staff training, and high initial and maintenance costs.2 In March 2021 issue of Neurospine, Staartjes et al.8 published an article to compare clinical outcomes following different robotic spine surgery techniques. The authors present a prospective cohort study that compares clinical outcomes and surgical variables of roboticguided minimally invasive transforaminal lumbar interbody fusion (TLIF) and roboticguided mini-open posterior lumbar interbody fusion (PLIF) procedures in patients with lumbar spinal stenosis and concomitant low-grade spondylolisthesis. The article provides detailed information including demographics, surgical time, length of stay, radiation exposure, and complications for each robotic-assisted surgery. The article provides well-described technical nuances and it shows overall safety profile of both robotic-guided approaches. The investigators collected preand postoperative patient-recorded outcome measures (PROM) over a period of 12-months, however, no significant difference was observed between the PLIF and TLIF experimental cohorts. In addition to the raw PROMs scores, authors outlined a framework for “minimum clinically important difference” (MCID) which was defined as a decrease of 30% or more from patient baseline. This analysis revealed that robot-guided PLIF (RG-PLIF) group showed greater postoperative improvement in terms of leg pain, however, this may be related to the fact that these patients have higher baseline visual analogue scale (VAS) leg pain scores compared to the robot-guided TLIF (RG-TLIF) Neurospine