Abstract
BACKGROUND: Robotic assistance in adult spinal deformity (ASD) surgery has been associated with improved pedicle screw accuracy and reduced blood loss and radiation exposure. However, evidence regarding early postoperative outcomes, complication profiles, and short-term readmissions in long-segment adult spinal deformity(ASD) surgeries remains limited. This study compared perioperative parameters and early functional outcomes between robotic-assisted and conventional open long-segment fusion for ASD. METHODS: We conducted a retrospective review of consecutive patients undergoing long-segment fusion for ASD (upper instrumented vertebra T10-T12, lower instrumented vertebra pelvis) at a tertiary spine center from June 2022 onward. Patients undergoing upper thoracic fixation, three-column osteotomies, non-instrumented procedures, or surgery for non-degenerative pathologies were excluded. Robotic-assisted minimally invasive fixation was compared with conventional open instrumentation. Estimated blood loss (EBL), operative duration, hospital length of stay, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), complications, 30-day readmissions, and mortality were analyzed. RESULTS: Seventy-four patients were included (34 robotic, 40 open), with comparable baseline characteristics. The robotic group demonstrated significantly lower EBL (745 ± 168 vs. 1026 ± 266 mL, p < 0.001), shorter operative time (227.6 ± 28.3 vs. 290.2 ± 30.5 min, p < 0.001), and reduced hospital stay (median 3 vs. 5.5 days, p < 0.001). Both groups showed significant 30-day improvements in ODI and VAS scores. ODI improvement was greater in the robotic cohort (6.9 ± 2.8 vs. 4.8 ± 2.5, p = 0.002; Cohen's d = 0.81), while VAS improvements were comparable. Complication rates, 30-day readmissions (8.1%), and mortality (0%) did not differ between groups. CONCLUSION: Robotic-assisted long-segment fusion for ASD was associated with reduced blood loss, shorter operative time, and decreased hospital stay, with improved early functional recovery and no increase in short-term complications.