National Utilization of Navigation and Robotics in Inpatient Spinal Fusion Remains Low but is Increasing, 2016–2022

Abstract

Study Design Retrospective cohort study. Objectives Adoption patterns in spinal fusion remain poorly defined at the national level. This study aimed to evaluate national adoption trends of navigation and robotics in spine fusion from 2016 to 2022. Methods The National Inpatient Sample was queried for adult spinal fusion hospitalizations between 2016 and 2022. Procedures were categorized as navigation-assisted, robotic-assisted, or conventional. Outcomes included frequency of utilization, complications, and discharge disposition. National estimates were generated using survey weights, and outcomes were compared across groups. Results Of 2,057,450 inpatient spinal fusions from 2016 to 2022, 152,155 (7.4%) incorporated technology—120,525 (5.9%) navigation and 31,630 (1.5%) robotics. Technology utilization increased from 2.7% in 2016 to 13.3% in 2022 (navigation 2.30% to 10.39%; robotics 0.36% to 2.90%). Mean unadjusted complication rates were 20.9% for conventional cases, 25.6% for navigation-assisted cases, and 22.4% for robotic-assisted cases, with non-routine discharge also varying across cohorts and spinal regions. However, these findings should be interpreted cautiously, as selection bias and unmeasured differences in case complexity likely influenced technology use and associated outcomes. Further study with more granular clinical data is needed to better define the relationship between these technologies and perioperative outcomes. Conclusions This national study characterized trends in navigation/robotic-assisted spinal fusion. Although adoption remained modest, robotics expanded at a steeper trajectory than navigation. Despite observed differences in unadjusted complication profiles across cohorts, these findings should be interpreted cautiously given likely selection bias and unmeasured case complexity, and prospective studies are needed to determine long-term outcomes.