[Application outcomes of robot-assisted screw placement in posterior instrumentation for lumbar spondylolysis with spondylolisthesis].

Objective

To explore the application value of the "TINAVI" orthopedic surgical robot with screw placement in lumbar spondylolysis with spondylolisthesis.

Methods

A retrospective cohort study was conducted to analyze clinical data of the patients with spondylolytic spondylolisthesis who underwent surgery at Xi'an Honghui Hospital, Xi'an Jiaotong University, from January 2023 to January 2024. The patients were divided into a robot-assisted group and a freehand group based on pedicle screw placement technique. Intraoperative time was recorded, and postoperative lumbar CT scans were performed on day 3 to evaluate screw placement satisfaction, cortical penetration rate, and facet joint violation using the Neo classification criteria. Clinical outcomes, including visual analogue scale (VAS) for low back pain and Oswestry disability index (ODI), were assessed preoperatively, at 3 days, 3 months, 6 months and final follow-up.

Results

A total of 208 patients were enrolled, including 77 males and 131 females with a mean age of (60.4±10.7) years; there were 65 cases in the robot-assisted group and 143 cases in the freehand group. All the patients were followed up for (15.7±3.1) months (12-24 months). The intraoperative time in the robot-assisted group was significantly shorter than that in the freehand group[(134.6±17.2) vs (148.0±20.7) min, P<0.001]. The screw placement satisfaction rate [96.9% (252/260) vs 87.1% (498/572)] and cortical penetration rate [8.1% (21/260) vs 28.7% (164/572)] were both superior in the robot-assisted group than those in the freehand group (both P<0.05). The proximal facet joint violation rate was lower in the robot-assisted group [7.7% (10/130) vs 22.4% (64/286), P<0.01]. The robot-assisted group and the freehand group both showed significant improvements in VAS and ODI scores from preoperative values [VAS: (5.22±0.74) vs (5.12±0.84)points; ODI: (36.32±3.82) vs (37.00±3.04) points] to all postoperative time points [3 months: VAS (2.20±0.78) vs (2.12±0.82) points; ODI (25.12±3.04) vs (25.70±3.44) points; 6 months: VAS (0.82±0.40) vs (0.70±0.62) points; ODI (14.31±3.20) vs (14.60±3.84) points; final follow-up: VAS (0.78±0.42) vs (0.68±0.30) points; ODI (13.20±3.20) vs (13.40±3.24) points, all P<0.05]. No significant intergroup differences were observed in VAS or ODI at any time point (all P>0.05). No major complications (e.g., neurovascular injury) occurred in either group.

Conclusion

The orthopedic surgical robot can significantly improve the accuracy of screw placement, reduce the inferior facet joint invasion rate and operation time in lumbar spondylolysis surgery, and has good application value for patients with lumbar spondylolysis with spondylolisthesis.