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<p>Robot-assisted (RA) spinal fusion is an emerging technology for the treatment of lumbar spondylolisthesis. However, its purported advantages currently lack robust empirical evidence. This study aimed to evaluate whether RA spinal fusion offered superior outcomes compared to fluoroscopy-guided (FG) techniques in management of lumbar spondylolisthesis.&#xa0;This study was prospectively registered with PROSPERO (CRD420251083476). A systematic review was conducted by searching six databases for studies comparing RA and FG spinal fusion in patients with lumbar spondylolisthesis, with data collected up to June 25, 2025. Meta-analysis was performed using Stata 17.0. The certainty of evidence was assessed in accordance with GRADE method.&#xa0;Eight studies were included in the meta-analysis. Compared to FG group, RA group demonstrated significantly longer operative duration [WMD = 47.37, 95% CI (40.65, 54.69), <i>p</i> &lt; 0.01] but exhibited reduced intraoperative blood loss [WMD = -106.19, 95% CI (-137.48, -74.9), <i>p</i> &lt; 0.01], lower postoperative drainage volume [WMD = -172.15, 95% CI (-188.68, -155.63), <i>p</i> &lt; 0.01], and shorter hospitalization length [WMD = -2.93, 95% CI (-3.29, -2.57), <i>p</i> &lt; 0.01]. Additionally, patients in RA group showed significantly lower postoperative visual analog scale scores and Oswestry disability index. According to Gertzbein and Robbins criteria, the rate of grade A pedicle screw placement accuracy was significantly higher in RA group than in FG group [OR = 2.17, 95% CI (1.29, 3.63), <i>p</i> &lt; 0.01]. No significant differences were observed between both groups in radiation exposure time, fusion rate, overall complication rate, or revision rate (<i>p</i> &gt; 0.05).&#xa0;In conclusion, RA spinal fusion appears to offer benefits in improving pedicle screw placement accuracy, reducing surgical trauma, and enhancing clinical outcomes. It also contributes to greater pain relief and faster recovery compared to conventional FG techniques. With the growing adoption of robotic-assisted spinal surgery and ongoing advancements in next-generation robotic systems, well-designed randomized controlled trials are warranted to further investigate the efficacy of RA technology in optimizing long-term prognosis and quality of life for patients with lumbar spondylolisthesis.</p>

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Robot-assisted versus fluoroscopy-guided spinal fusion for lumbar spondylolisthesis: a GRADE-assessed meta-analysis on surgical parameters, clinical outcomes, and complications

  • 期刊论文

  • 发表日期：

    2026年1月20日

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  • Yu Zhang,
  • Jidong Ju,
  • Jinchun Wu

摘要

Robot-assisted (RA) spinal fusion is an emerging technology for the treatment of lumbar spondylolisthesis. However, its purported advantages currently lack robust empirical evidence. This study aimed to evaluate whether RA spinal fusion offered superior outcomes compared to fluoroscopy-guided (FG) techniques in management of lumbar spondylolisthesis. This study was prospectively registered with PROSPERO (CRD420251083476). A systematic review was conducted by searching six databases for studies comparing RA and FG spinal fusion in patients with lumbar spondylolisthesis, with data collected up to June 25, 2025. Meta-analysis was performed using Stata 17.0. The certainty of evidence was assessed in accordance with GRADE method. Eight studies were included in the meta-analysis. Compared to FG group, RA group demonstrated significantly longer operative duration [WMD = 47.37, 95% CI (40.65, 54.69), p < 0.01] but exhibited reduced intraoperative blood loss [WMD = -106.19, 95% CI (-137.48, -74.9), p < 0.01], lower postoperative drainage volume [WMD = -172.15, 95% CI (-188.68, -155.63), p < 0.01], and shorter hospitalization length [WMD = -2.93, 95% CI (-3.29, -2.57), p < 0.01]. Additionally, patients in RA group showed significantly lower postoperative visual analog scale scores and Oswestry disability index. According to Gertzbein and Robbins criteria, the rate of grade A pedicle screw placement accuracy was significantly higher in RA group than in FG group [OR = 2.17, 95% CI (1.29, 3.63), p < 0.01]. No significant differences were observed between both groups in radiation exposure time, fusion rate, overall complication rate, or revision rate (p > 0.05). In conclusion, RA spinal fusion appears to offer benefits in improving pedicle screw placement accuracy, reducing surgical trauma, and enhancing clinical outcomes. It also contributes to greater pain relief and faster recovery compared to conventional FG techniques. With the growing adoption of robotic-assisted spinal surgery and ongoing advancements in next-generation robotic systems, well-designed randomized controlled trials are warranted to further investigate the efficacy of RA technology in optimizing long-term prognosis and quality of life for patients with lumbar spondylolisthesis.