Objective:

To evaluate differences in opioid use, patient-reported outcomes, and screw accuracy between robotic-assisted (RA) and fluoroscopy-assisted (FA) techniques in single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Approach:

• Study Design: A retrospective cohort study was conducted using a database of patients who underwent single-level MIS-TLIF for degenerative lumbar pathology by a single surgeon between 2019 and 2024.
• Patient Grouping: Patients were grouped based on pedicle screw placement technique (RA vs. FA).
• Outcomes Measured: Primary outcomes included inpatient opioid consumption, long-term opioid use, and patient-reported outcomes (PROs) such as Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores.

Key Findings:

• The RA group demonstrated significantly improved screw accuracy, with 91% of screws graded A compared to 57% in the FA group (p < 0.001).
• Inpatient opioid consumption was significantly lower in the RA group on postoperative days 0–1 (p = 0.002) and across total length of stay (LOS) (p = 0.0015).
• Long-term opioid use at 3, 6, and 12 months was similar between groups (p > 0.05).
• Both groups showed significant improvement in ODI and VAS scores at 6 and 12 months (p < 0.05), with no between-group differences.

Interpretation:

RA MIS-TLIF had improved pedicle screw accuracy and reduced early postoperative opioid consumption compared to FA techniques; however, these advantages did not translate into reduced long-term opioid use or improved patient-reported outcomes.

Limitations:

• The study was retrospective and conducted at a single institution.
• Only elective, single-level MIS-TLIF surgeries performed by a single surgeon were included, which may limit generalizability.

Conclusion:

RA MIS-TLIF showed enhanced screw placement accuracy and decreased early opioid consumption, but did not result in lower long-term opioid use or better patient-reported outcomes.