Efficacy and safety of robot-assisted pedicle screw placement in lumbar spondylolisthesis: a meta-analysis

This systematic review and meta-analysis aimed to evaluate the differences in efficacy and safety between robotic navigated pedicle screw insertion and conventional free-hand techniques in the management of lumbar spondylolisthesis. Utilizing a predefined search strategy, we systematically searched four major biomedical databases-PubMed, Cochrane Library, Web of Science, and Embase-up to January 27, 2025. After rigorous screening, six eligible clinical studies (comprising prospective cohort studies and retrospective analyses) involving 260 patients in total were incorporated into the quantitative synthesis. The primary outcomes measured included screw placement accuracy, operative time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), and the incidence of complications. The results revealed that robot-assisted pedicle screw placement significantly outperformed traditional manual placement regarding screw placement accuracy, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and VAS score (P < 0.05). However, robot-assisted surgery was linked to a notably longer surgical duration compared to manual methods (WMD > 0, P < 0.05). To summarize, robot-assisted pedicle screw placement demonstrates significant advantages over traditional manual placement in the management of lumbar spondylolisthesis, with its safety and efficacy further validated.