Application of orthopedic robot-assisted navigation in unilateral biportal endoscopy for single-level lumbar spinal stenosis

English Keywords:Lumbar spinal stenosis  Unilateral biportal endoscopy  Orthopedic robot-assisted navigation

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical value of orthopedic robot-assisted navigation in unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF) for the treatment of lumbar spinal stenosis. Methods: A retrospective analysis was performed on the clinical data of 35 patients with single level lumbar spinal stenosis who underwent surgery at the Second Traditional Chinese Medicine Hospital of Guangdong Province from January 2024 to March 2025. Among them, 18 patients(robot group) received orthopedic robot-assisted UBE-TLIF(8 males, 10 females; mean age 56.89±7.95 years), and 17 patients(conventional group) underwent conventional UBE-TLIF(9 males, 8 females; mean age 58.82±8.68 years). There were no significant differences between the two groups in baseline characteristics, including sex, age, involved segment, comorbidities, disease duration, bone mineral density grade, and MSU grading and zoning system for disc herniation(P>0.05). The following parameters were compared, including operative time, screw placement time, fluoroscopy frequency, intraoperative blood loss, screw placement accuracy(proportion of grade A screws according to the Gertzbein-Robbins classification), and facet joint violation. Clinical outcomes were assessed using the visual analogue scale(VAS) and the Oswestry disability index(ODI) preoperatively and at 1 week, 1 month, 3 months, 6 months, and the final follow-up postoperatively. Results: All surgeries were completed successfully. No significant difference was found in operative time between the two groups(156.72±14.22min vs 161.29±14.20min, P>0.05). Compared with the conventional group, the robot group had significantly fewer fluoroscopic exposures(7.11±1.45 vs 23.00±2.42, P<0.05) and significantly shorter screw placement time(35.72±3.10min vs 46.00±6.32min, P<0.05). The screw placement accuracy rate in the robot group was significantly higher than that in the conventional group(98.6% vs 88.2%, P<0.05). Regarding facet joint violation, in the robot group, 62 screws(86.1%) were of grade 0, 7(9.7%) of grade 1, and 3(4.2%) of grade 2; And in the conventional group, 47 screws(69.1%) were of grade 0, 12(17.6%) of grade 1, and 9(13.2%) of grade 2. There was a statistically significant difference between the two groups(P<0.05). Both groups showed significant improvements in VAS and ODI scores at all postoperative time points compared with baseline(P<0.05), but there were no significant intergroup differences at any corresponding time point(P<0.05). Conclusions: In the surgical treatment of single level lumbar spinal stenosis, robot navigation assisted UBE-TLIF is higher in screw placement efficiency, less in intraoperative radiation exposure, and greater in screw accuracy compared with conventional UBE-TLIF.