Background and Objectives: Spine surgery has undergone significant advancements, particularly with regard to robotic systems that enhance surgical techniques and improve patient outcomes. As these technologies become increasingly integrated into surgical practice, it is essential to evaluate their added value and cost savings. Hence, this study compared robot-assisted and navigation-based spine surgery, focusing on surgical efficiency. Materials and Methods: We conducted a single-center, retrospective cohort study of patients undergoing single- and double-level transforaminal lumbar interbody fusion (TLIF) and oblique lumbar interbody fusion (OLIF) surgeries. Patients were divided into two groups: those who had robot-assisted and navigation-based surgeries, stratified by surgery type (TLIF or OLIF) and fusion levels (one or two). A comparative analysis of factors related to surgical efficiency, including operative duration, blood loss, and length of hospital stay, was conducted. Results: Our results showed a statistically significant reduction in operative duration for robot-assisted one- and two-level OLIF cases, with average time savings of 50 and 62 min, respectively, compared to navigation-based surgery. These time savings translated to an estimated cost reduction of SGD 1500 for the hospital for each patient for a two-level OLIF procedure and could be higher as the number of operated levels increase. Conclusions: These results indicated that robot-assisted spine surgery offers superior surgical efficiency and cost savings, particularly with increased numbers of surgical levels. As robotic technologies evolve, their integration into spine surgery is justified, promising improved patient outcomes and cost-effectiveness.

Adjacent segment problems after cervical spine instrumentation are widely reported. They can range from asymptomatic adjacent segment degeneration (ASD) noted on radiographs to symptomatic adjacent segment disease and even instability. While ASD following anterior instrumentation is well studied, there is a paucity of literature on ASD following posterior instrumentation. We intended to identify the risk factors associated with ASD following posterior instrumentation, focusing on pre-operative and surgical parameters. Eighty-seven patients who underwent posterior instrumentation of the cervical spine were recruited. Clinical and radiological examination was performed preoperatively and up to 24 months postoperatively. The collected data included patient demographics, indication for surgery, sagittal parameters (cervical lordosis, C2–7 sagittal-vertical axis), technique of surgery, number of levels instrumented and fused, number of levels decompressed, and the level at which the instrumentation ended. Based on postoperative evaluation, ASD was found in 29.9% of the patients, of which, one patient was symptomatic and required reoperation. Even though, according to our univariate analysis, reduced pre-operative cervical lordosis and the indication of degenerative spondylosis seemed to significantly influence the occurrence of ASD, multivariate regression analysis did not identify any independent risk factors. We also noted that, even though patients may develop ASD after the instrumented fusion of the cervical spine, this may not necessarily develop into symptomatic adjacent segment disease requiring revision surgery.