Robotic-assisted minimally invasive transforaminal lumbar interbody fusion: A meta-analysis of perioperative and postoperative outcomes

Degenerative lumbar spinal diseases are a leading cause of disability worldwide, often requiring surgical intervention when conservative management fails. Transforaminal lumbar interbody fusion (TLIF) is a commonly employed procedure to stabilize the spine and alleviate symptoms. This systematic review and meta-analysis aimed to test the safety and efficacy of robotic-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) in managing degenerative lumbar spinal diseases. Our primary objective was to compare the robotic approach with the conventional open or minimally invasive approach for TLIF regarding patients' perioperative and postoperative outcomes.

PubMed, Cochrane Library, Scopus, and Embase were searched from inception until October 2023. The selection criteria included only English-language articles focused on human participants aged 18 years and older with measurable outcomes. Prospective and retrospective cohort studies were included. Relevant data regarding perioperative outcomes and postoperative pain scores were then extracted. Review Manager (RevMan) 5.4 was used for statistical analysis. No restrictions were applied regarding the surgical approach compared to the robotic approach. This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Twelve observational studies, including 1,385 patients, were included in our final analysis. Robotic-assisted minimally invasive lumbar interbody fusion was associated with significantly lower blood loss compared to both open (MD: -161.11 mL [95% CI, -184.89 to -137.34]) and conventional minimally invasive surgery (MD: -25.18 mL [95% CI, -64.06 to 13.70]), with an overall significant reduction (MD: -76.27 mL [95% CI, -118.65 to -33.90]). Operative time was significantly longer in robotic surgery compared to non-robotic approaches (MD: 17.61 minutes [95% CI, 4.10 to 31.11]). Hospital stay was shorter in the robotic group than in the non-robotic surgery group (MD: -0.89 days [95% CI, -1.54, -0.24]). Radiation time and dose showed no significant differences. Postoperative pain and functional outcomes, including ODI and VAS scores, showed a trend toward improvement in the robotic group but did not reach statistical significance.

Robotic-assisted minimally invasive TLIF shows promising results in operative time and blood loss compared to open or minimally invasive TLIF.