Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis

Objective: To compare the clinical efficacy between robot-assisted minimally invasive transforaminal lumbar interbody fusion (robot-assisted MIS-TLIF) and traditional open TLIF surgery in the treatment of lumbar spondylolisthesis.

Methods: According to the inclusion and exclusion criteria, 48 cases with lumbar spondylolisthesis who received surgical treatment from June 2016 to December 2017 in the spinal surgery department of Beijing Jishuitan Hospital were analyzed in this study, including 23 patients who received robot-assisted MIS-TLIF and 25 patients who received traditional open TLIF surgery. The two groups were compared in terms of pedicle screw accuracy evaluated by Gertzbein-Robbins classification on postoperative computed tomography (CT), operation time, blood loss, postoperative drainage, hospitalization, time to independent ambulation, low back pain evaluated by visual analog scale (VAS), lumbar function evaluated by Oswestry Disability Index (ODI), paraspinal muscles atrophy on magnetic resonance imaging (MRI), and complications.

Results: Postoperative CT showed that the rate of Grade A screws in the robot-assisted MIS-TLIF group was significantly more than that in the open surgery group (χ = 4.698, P = 0.025). Compared with the open surgery group, the robot-assisted MIS-TLIF group had significantly less intraoperative blood loss, less postoperative drainage, shorter hospitalization, shorter time to independent ambulation, and lower VAS at 3 days post-operation (P < 0.05). However, the duration of surgery was longer. The VAS of the robot-assisted MIS-TLIF group decreased from 6.9 ± 1.8 at pre-operation to 2.1 ± 0.8 at post-operation, 1.8 ± 0.7 at 6-month follow-up and 1.6 ± 0.5 at 2-year follow-up. The VAS of the open surgery group decreased from 6.5 ± 1.7 at pre-operation to 3.7 ± 2.1 at post-operation, 2.1 ± 0.6 at 6-month follow-up and 1.9 ± 0.5 at 2-year follow-up. The ODI of the robot-assisted MIS-TLIF group decreased from 57.8% ± 8.9% at pre-operation to 18.6% ± 4.7% at post-operation, 15.7% ± 3.9% at 6-month follow-up and 14.6% ± 3.7% at 2-year follow-up. The ODI of the open surgery group decreased from 56.9% ± 8.8% at pre-operation to 20.8% ± 5.1% at post-operation, 17.3% ± 4.2% at 6-month follow-up and 16.5% ± 3.8% at 2-year follow-up. Paraspinal muscle cross-sectional area in 2-year follow-up in patients of the open surgery group decreased significantly compared to patients of robotic-assisted MIS-TLIF group (P = 0.016).

Conclusion: In the treatment of lumbar spondylolisthesis, robot-assisted MIS-TLIF may lead to more precise pedicle screw placement, less intraoperative blood loss, less postoperative drainage, less postoperative pain, quicker recovery, and less paraspinal muscle atrophy than traditional open surgery.