Minimally Invasive Robotic-Assisted Complex Adult Spinal Deformity Correction in a Surgical Specialty Hospital: Bringing Adult Spinal Deformity Care Closer to Home

Background/Objectives: Adult spinal deformity (ASD) correction is a complex surgery to restore spinal alignment and relieve patients’ symptoms. Modern techniques and technologies allow for aggressive surgical correction in tissue-friendly ways that preserve anatomy and may enable faster recovery. Robotic-assisted posterior spinal stabilization may be used as an adjunct to complex ASD reconstruction to facilitate a minimally invasive approach, reduce perioperative morbidity and physiological insult, and allow for the performance of procedures traditionally reserved for large academic centers to be effectively performed by qualified surgeons in optimized patients at smaller hospitals with fewer resources. The objective of this study is to assess realignment, perioperative complications, and patient-reported outcomes of complex, minimally invasive, robotic-assisted adult spinal deformity correction in a surgical specialty hospital. Methods: Demographic, surgical, and perioperative data were collected from the medical record. The Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for pain scores were collected preoperatively and at regular post-op visits. X-rays were captured preoperatively before hospital discharge and at follow-up visits. Results: Fifty consecutive deformity patients were corrected with a two-stage approach (anterior column reconstruction followed by posterior stabilization with robotic-assisted screw placement on the next day) at a 48-bed (eight operating rooms), surgeon-owned, subspecialty hospital. The average patient age was 70 years, and 64% were female. The average estimated blood loss (EBL) values for the first and second stages were 62 mL and 205 mL, respectively. The average operative time was 172 min during the first stage and 210 min for the second stage. Three interbody spacers (first stage) and 16 screws (second stage) were inserted on average in each procedure. The average length of stay (LOS) in the hospital was 5 days, and the average follow-up period was 10.6 months. No patients required a transfer to another facility with intensive care unit (ICU) capabilities, and none required a revision of hardware placement. There was an average reduction in the lumbar coronal scoliotic curve of 14.5° and an increase in lumbar lordosis of 14.8° at the latest follow-up (p < 0.01). The average mismatch between pelvic incidence and lumbar lordosis (PI-LL) preoperatively was 17.6°, which was reduced to 9.6° at the latest postoperative follow-up (p < 0.01). Mean ODI (%) and NRS scores were significantly improved by 33.8% (46.7 ± 13.3 to 30.9 ± 19.8; p < 0.01) and 55% (6.0 ± 2.2 to 2.7 ± 2.6; p < 0.01), respectively, at last follow-up. Conclusions: This study demonstrates the feasibility of performing complex, robotic-assisted ASD corrective surgery in a surgical specialty hospital, achieving significant correction of sagittal and coronal deformities, relieving patients’ symptoms, and offering efficiency and consistency to pedicle screw placement. This study demonstrates that a minimally invasive approach to complex deformity reconstruction reduces perioperative morbidity with decreased operative times, EBL, and LOS when compared to historic controls. This approach allows for the democratization of deformity care in that procedures typically reserved for large academic centers can be successfully accomplished at smaller institutions in optimized patients by qualified surgeons with appropriate perioperative support staff.