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

Study Summary

8 studies including 400 patients with lumbar spondylolisthesis were included in this systematic review and meta-analysis comparing robot-assisted spinal fusion (RA-SF) vs fluoroscopy-guided spinal fusion (FG-SF). Pooled outcomes of interest included operative time, intraoperative blood loss, radiation exposure time, pedicle screw placement accuracy, postoperative drainage volume, visual analogue scale (VAS) pain scores, Oswestry Disability Index (ODI), hospital stay, fusion rate, complication rate, and revision rate. RA-SF was associated with greater pedicle screw placement accuracy, less intraoperative blood loss, lower postoperative drainage, shorter hospital stay, and improved pain and disability scores, but it had longer operative duration and did not significantly affect radiation exposure time, fusion, complications, or revisions. Overall, these findings suggest that RA-SF may improve technical precision and early recovery outcomes in lumbar spondylolisthesis, but its routine use should be guided by patient selection, surgical complexity, resources, and further randomized evidence.