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.

Keywords

lumbar spondylolysis / minimally invasive surgery / pedicle screw / robot-assisted surgery / spinal endoscopy

References

[1] W. J. Beutler, B. E. Fredrickson, A. Murtland, C. A. Sweeney, W. D. Grant, and D. Baker, “The Natural History of Spondylolysis and Spondylolisthesis: 45-Year Follow-Up Evaluation,” Spine 28 (2003): 1027-1035.

[2] R. Cavalier, M. J. Herman, E. V. Cheung, and P. D. Pizzutillo, “Spondylolysis and Spondylolisthesis in Children and Adolescents: I. Diagnosis, Natural History, and Nonsurgical Management,” Journal of the American Academy of Orthopaedic Surgeons 14 (2006): 417-424.

[3] R. C. Cassidy, W. O. Shaffer, and D. L. Johnson, “Spondylolysis and Spondylolisthesis in the Athlete,” Orthopedics 28 (2005): 1331-1333.

[4] T. Ikata, R. Miyake, S. Katoh, T. Morita, and M. Murase, “Pathogenesis of Sports-Related Spondylolisthesis in Adolescents. Radiographic and Magnetic Resonance Imaging Study,” American Journal of Sports Medicine 24 (1996): 94-98.

[5] W. Wang, Z. Liu, P. Lyu, S. Zhang, and H. Bai, “Biportal Endoscopic Bone Graft Repair and Percutaneous Screw Fixation for Lumbar Spondylolysis-Technical Note and Clinical Outcomes,” Acta Neurochirurgica 166 (2024): 58.

[6] Z. Li, J. Chen, Q. A. Zhu, et al., “A Preliminary Study of a Novel Robotic System for Pedicle Screw Fixation: A Randomised Controlled Trial,” Journal of Orthopaedic Translation 20 (2020): 73-79.

[7] G. Y. Cui, X. G. Han, Y. Wei, et al., “Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis,” Orthopaedic Surgery 13 (2021): 1960-1968.

[8] I. H. Lieberman, M. A. Hardenbrook, J. C. Wang, and R. D. Guyer, “Assessment of Pedicle Screw Placement Accuracy, Procedure Time, and Radiation Exposure Using a Miniature Robotic Guidance System,” Journal of Spinal Disorders & Techniques 25 (2012): 241-248.

[9] J. Li, Z. Wang, L. Zeng, Z. Liu, W. Hu, and M. Yu, “Application and Evaluation of an Independent Robotic Arm System in K-Wire Placement for Lumbar Fusion,” Clinical Spine Surgery 34 (2021): E466-E476.

[10] S. D. Gertzbein and S. E. Robbins, “Accuracy of Pedicular Screw Placement in Vivo,” Spine (Phila Pa 1976) 15 (1990): 11-14.

[11] N. V. Mohile, A. S. Kuczmarski, D. Lee, C. Warburton, K. Rakoczy, and A. J. Butler, “Spondylolysis and Isthmic Spondylolisthesis: A Guide to Diagnosis and Management,” Journal of American Board of Family Medicine 35 (2022): 1204-1216.

[12] E. V. Cheung, M. J. Herman, R. Cavalier, and P. D. Pizzutillo, “Spondylolysis and Spondylolisthesis in Children and Adolescents: II. Surgical Management,” Journal of the American Academy of Orthopaedic Surgeons 14 (2006): 488-498.

[13] G. V. Johnson and A. G. Thompson, “The Scott Wiring Technique for Direct Repair of Lumbar Spondylolysis,” Journal of Bone and Joint Surgery. British Volume 74 (1992): 426-430.

[14] M. Kakiuchi, “Repair of the Defect in Spondylolysis. Durable Fixation With Pedicle Screws and Laminar Hooks,” Journal of Bone and Joint Surgery. American Volume 79 (1997): 818-825.

[15] M.-l. Feng, H.-l. Shen, Y.-m. Yong, et al., “Analysis of Factors Related to Prognosis and Curative Effect for Posterolateral Fusion of Lumbar Low-Grade Isthmic Spondylolisthesis,” International Orthopaedics 33 (2009): 1335-1340.

[16] J. E. Lang, S. Mannava, A. J. Floyd, et al., “Robotic Systems in Orthopaedic Surgery,” Journal of Bone and Joint Surgery (British Volume) 93B (2011): 1296-1299.

[17] J.-Q. Wang, Y. Wang, Y. Feng, et al., “Percutaneous Sacroiliac Screw Placement: A Prospective Randomized Comparison of Robot-Assisted Navigation Procedures With a Conventional Technique,” Chinese Medical Journal 130 (2017): 2527-2534.

[18] M. He, W. Han, C.-p. Zhao, et al., “Evaluation of a bi-Planar Robot Navigation System for Insertion of Cannulated Screws in Femoral Neck Fractures,” Orthopaedic Surgery 11 (2019): 373-379.

[19] Y. Guo, W. Ma, D. Zlotolow, C. Wang, D. Tong, and K. Liu, “A Comparison Between Robotic-Assisted Scaphoid Screw Fixation and a Freehand Technique for Acute Scaphoid Fracture: A Randomized, Controlled Trial,” Journal of Hand Surgery. American Volume 47 (2022): 1172-1179.

[20] W. Zhao, Y. Wang, H. Zhang, et al., “Analysis of the Screw Accuracy and Postoperative Efficacy of Screw Placement in Single Position and Bipedal Position in Robot-Assisted Oblique Lumbar Interbody Fusion: Preliminary Results of Mazor X Stealth Usage,” Orthopaedic Surgery 16 (2023): 401-411.

[21] S. Lin, F. Wang, J. Hu, and L. Y. Tang, “Comparison of the Accuracy and Safety of TiRobot-Assisted and Fluoroscopy-Assisted Percutaneous Pedicle Screw Placement for the Treatment of Thoracolumbar Fractures,” Orthopaedic Surgery 14 (2022): 2955-2963.

RIGHTS & PERMISSIONS

2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.