Robot-Assisted Screw Fixation Combined With Endoscopic Bone Graft in the Minimally Invasive Treatment of Lumbar Spondylolysis: A Single-Center Retrospective Study.

Abstract

Objective: Spondylolysis, often progressing to spondylolisthesis, commonly defies conservative treatment in refractory cases, indicating a need for surgery. Robot-assisted techniques may provide a stable and effective minimally invasive approach for the treatment of lumbar spondylolysis. To compare the clinical efficacy between robot-assisted percutaneous screw fixation combined with endoscopic bone graft and conventional open screw fixation with bone graft in the treatment of lumbar spondylolysis.

Methods: A cohort study involving 43 individuals with lumbar spondylolysis who underwent surgical treatment was conducted. From January 2022 to June 2023, 20 patients underwent percutaneous screw fixation combined with endoscopic bone graft while 23 patients underwent conventional open screw fixation with bone graft. The demographic data, parameters related to robotic surgery, perioperative indicators, VAS and ODI scores, pedicle screw accuracy, radiographic fusion outcomes, and follow-up results were systematically recorded, analyzed, and then compared between the two groups. Categorical variables were analyzed using chi-square tests, and continuous variables were evaluated with t-tests or Mann-Whitney U tests following normality assessment, with statistical significance at p < 0.05.

Results: Compared with the conventional surgery group, the robot-assisted surgery group had significantly less intraoperative blood loss, less postoperative drainage, shorter hospital stay, less intraoperative fluoroscopy times, and radiation exposure dose (p < 0.05). Nevertheless, the duration of the surgery was longer. Postoperative imaging findings showed high screw accuracy in both groups, with a grade A rate of 95% in the robot-assisted group compared with 91.4% in the conventional open surgery group according to the Gertzbein-Robbins scale. Both groups achieved similar improvements in VAS and ODI during 1-year follow-up, and both groups achieved good bone graft fusion (97.5% fusion rate in the robot-assisted group versus 93.5% in the conventional open surgery group).

Conclusion: Robot-assisted screw fixation combined with endoscopic bone graft provides a safe and reliable minimally invasive treatment of lumbar spondylolysis, with high accuracy of pedicle screw implantation and less radiation exposure dose, less intraoperative trauma, and quicker recovery than conventional open surgery.