For a multi-centre cohort study, researchers wanted to evaluate the robot time/screw, radiation exposure, robot abandonment, screw accuracy, and 90-day outcomes for brief lumbar fusion using a robot-assisted percutaneous versus a robot-assisted open method (1- and 2-level). The evidence for the superiority of robot-assisted minimally invasive spine surgery over open procedures is mixed. A large, multicenter study is needed better to understand the outcomes and consequences of these 2 techniques. Adult patients (≥18 years old) who underwent robot-assisted brief lumbar fusion surgery at 4 different institutions from 2015 to 2019 were included in the study. A propensity score matching method was used to control for any selection bias between percutaneous and open surgery. After the index surgery, a minimum of 90 days of follow-up was required. Only 310 patients remained after propensity score matching. The Charlson comorbidity index was 1.6 (1.5) on average, with 53% female patients. High-degree spondylolisthesis (grade>2) (48%), degenerative disc disease (22%), and spinal stenosis (25%) were the most common diagnoses, with an average of 1.5 instrumented levels (0.5). The open group’s operative time was longer (198 minutes) than the percutaneous group’s (167 minutes, P=0.007). The robot time/screw, on the other hand, was comparable among cohorts (P>0.05). The percutaneous group’s fluoroscopy time/screw (14.4 s) was longer than the open group’s (10.1 s, P-value=0.021). Screw exchange and robot abandonment rates were comparable across groups (P>0.05). The open group had a higher estimated blood loss (146 mL vs. 61.3 mL, P<0.001) and a higher transfusion rate (3.9% vs. 0%, P=0.013). The mean length of stay and 90-day complication rate was not different between cohorts (P>0.05). For short-lumbar fusion, percutaneous robot-assisted spine surgery may result in more radiation exposure. Still, it can also result in a shorter operative duration and a lower risk of intraoperative blood loss. Other short-term postoperative results do not appear to be improved by percutaneous methods. Longer fusion operations will require multicenter research in the future and the inclusion of patient-reported outcomes.
