Robotic Vs Open Fixation for Traumatic Spine Injuries a Case Control Study

Unstable traumatic fractures of the thoracolumbar spine require surgical stabilization. The necessity to restore stability and sagittal balance after trauma is crucial for early patient mobilization and long term spinal function. The traditional fixation method is open pedicle screw fixation allowing reduction and stabilization of the broken segments. In recent years, several studies have indicated percutaneous fixation for traumatic thoracolumbar fractures is advantageous in aspects of infection rate, blood loss and hospitalization time. The challenge of the percutaneous fixation is that it is radiation heavy and requires a steep learning curve. Previous work showed that using robotic assisted pedicle screws is safe and is low on radiation. In this study, we compare our results for PSF in open versus percutaneous fixation for traumatic thoracolumbar fractures in a single trauma center.

Materials and methods:

All patients with traumatic vertebral fractures, who underwent PSF in a level one trauma center between 2006-2018 were enrolled. Retrospective data of demographics (age, sex, comorbidities), mechanism of injury, level of injury, level and method of fixation, laboratory results (hemoglobin and hematocrite before and after surgery), requirement of blood products, length of hospital stay, discharge destination, segmental kyphosis preoperative and final and complications were collected.

Results: during the study period 88 patients underwent PSF for traumatic fractures, of them 44 patients were matched for each group. Demographic data (age, sex, mechanism of injury) and fixation level (4.57 and 3.7 levels in ORIF and CRIF accordingly) were not statistically significant (P>0.05). number of fixated levels, requirement of blood products, surgery and anesthesia time and hospitalization duration was significantly better in CRIF group.

Conclusion

In our experience we have found that robotic assisted percutaneous fixation for traumatic thoracolumbar fractures is superior to open fixation in surgical duration, hospitalization time and patient outcomes in neurological status and hemodynamic parameters.

In our experience, PSF with robotic assisted percutaneous fixation is the preferred surgical method for treatment of unstable traumatic thoracolumbar fractures.