Outpatient robotic-assisted lumbar spinal fusion using the Mazor X Stealth Edition

ABSTRACT

Background: Enabling technologies such as robotic assistance for lumbar fusions are being combined with minimally invasive surgical (MIS) techniques to optimize patient outcomes. During the COVID-19 pandemic, substantial restrictions in performing inpatient spine surgeries were encountered. Thus, an opportunity to consider outpatient lumbar fusions was presented. This report summarizes a single surgeon's experience of outpatient lumbar fusions using robotic-assisted MIS techniques. Methods: A retrospective review of prospectively collected cases from a single-surgeon, multi-institution database was performed for all robotic-assisted lumbar fusions. Data including patient demographics, diagnosis, procedure type, operating room time, robot time, blood loss and complications were analyzed. Results: A total of 98 robotic-assisted lumbar fusions were performed. Of these, 22 (22%) cases were performed on an outpatient basis, at the hospital. Two of the patients were male and 10 were female. Average age was 60 years (range 32-80 yr) and average body mass index was 27.3 (range 20-34). Nineteen of the cases were considered primary surgery, and 3 were revisions. The most common indications for lumbar fusion were spondylolisthesis, spinal stenosis and spondylolysis. Techniques for fusion included transforaminal lumbar interbody fusion (18), posterior lumbar interbody fusion (3) and oblique lateral interbody fusion (1). All instrumentation was placed using a percutaneous, roboticassisted technique, using either the Mazor X or the Mazor X Stealth Edition.Twenty cases were 1 level, 1 case was 2 level and 1 case was 3 level. Average surgery time was 146.9 minutes (range 90-224 min), and robot time was 28.3 minutes (range 17-50 min). Average time was similar between the private, community hospital (surgery time 151.7 min, robot time 29.3 min) and the academic medical centre (surgery time 142.1 min, robot time 27.3 min). There were no procedurerelated complications or any complications that required admitted to hospital a patient with a planned outpatient stay. Two patients developed urinary retention requiring in/out catheterization before discharge. One male patient returned to the emergency department for urinary retention requiring catheterization and 1 female patient returned for leg edema. Conclusion: Outpatient lumbar fusions can be safely and successfully performed using MIS and robotic-assisted techniques, especially when hospital bed availability is limited.