©The Author(s) 2025.
World J Orthop. Nov 18, 2025; 16(11): 110276
Published online Nov 18, 2025. doi: 10.5312/wjo.v16.i11.110276
Published online Nov 18, 2025. doi: 10.5312/wjo.v16.i11.110276
Table 2 Combined accuracy and perioperative outcomes of included studies
| Ref. | Classification | RA accuracy (grade A) | Comparator accuracy (grade A) | Statistical significance | Clinically acceptable screws (A + B) | Statistical significance | Operative time (RA vs comparator) | EBL (mL) (RA vs comparator) | Radiation exposure (RA vs comparator) | Notes |
| Wang et al[1], 2023 | Gertzbein-Robbins | 85.4% | 69.5% | P < 0.001 | 97.1% vs 95.0% | NS | 160.25 ± 12.13 vs 154.35 ± 15.00 (P = 0.018) | 78.85 ± 33.52 vs 82.90 ± 20.91 (NS) | Surgeon: 13.28 ± 3.09 vs 94.87 ± 6.02 (P < 0.001) patient: NSD (NS) | Less disc height loss at adjacent segments (P < 0.001) |
| Tong et al[2], 2024 | Gertzbein-Robbins | 95.4% | 85.5% | P < 0.05 | 98.4% vs 95.5% | P = 0.04 | 158.8 minutes vs 129.9 minutes (P < 0.05) | 89.8 vs 117.3 (P < 0.05) | 13.3 vs 48.5 fluoroscopy counts (P < 0.05) | Longer operative time in RA but reduced blood loss and radiation exposure. Higher screw accuracy (98.4% vs 95.5%) |
| Shafi et al[3], 2022 | Gertzbein-Robbins | 88.5% | 88.4% | NS | 97.4% vs 95.3% | NS | Not reported | Not reported | Surgeon: Significantly lower with RN (P < 0.001) | Fewer high-grade breaches (0% RN vs 1.2% ION, P = 0.05) |
| Griepp et al[4], 2024 | Gertzbein-Robbins | Not directly reported; lower revision rate (0%) in RA suggests higher accuracy | Not reported; higher revision rate (2.4%) in FA group | P = 0.03 (lower revision rate in RA group) | Not reported | Not reported | 33.3 ± 8.57 minutes/screw vs 30.7 ± 6.87 minutes/screw, P = 0.125) | 161.4 ± 365.7 vs 155.1 ± 194.7 (NS) | 4.9 ± 7.6 vs 20.3 ± 14.0 mGy/screw (P < 0.001) | RA had longer anesthesia time (49.1 minutes/screw vs 43.6 minutes/screw, P = 0.009) |
| Lin et al[5], 2022 | Gertzbein-Robbins | 99.7% | 98.2% | P = 0.04 | 99.7% vs 98.2% | P = 0.04 | 280.7 vs 251.4 minutes (NS) | 313.7 vs 431.6 mL (P = 0.019) | Not reported | RA reduced blood loss significantly. Shorter operative time for 4-level surgeries with RA. No difference in complications or pain outcomes |
| Li et al[6], 2025 | Gertzbein-Robbins | 96.8% | 92.9% | NS | 99.2% vs 98.2% | NS | 147 minutes vs 165 minutes (P = 0.04) | 124.4 vs 138.9 (NS) | 54.6 seconds vs 87.8 seconds (P < 0.01) | Shorter fluoroscopy and operative time in RA, no significant difference in blood loss |
| Heath et al[7], 2024 | Gertzbein-Robbins | 98.0% | 80.0% | P < 0.001 | 100% vs 92.1% | P = 0.003 | 263.5 minutes vs 243.4 minutes (P = 0.28) | 340.6 vs 256.6 (NS) | Not quantified (O-arm used in both groups) | Longer operative time for RA in 2-level fusions (324.7 vs 266.4 min, P = 0.03). No medial breaches or revisions in either group |
| Chang et al[11], 2022 | Gertzbein-Robbins | 99.1% | 93.7% | P < 0.05 | 100% vs 98.4% | P = 0.001 | 208 ± 15.2 minutes vs 161 ± 7.9 minutes (P = 0.02) | 25 ± 10 vs 100 ± 20 (P = 0.01) | Reduced (implied, not quantified) | RA-TLIF had shorter incisions (1.4 cm vs 2.5 cm, P = 0.01). Lower screw misplacement rate (0.9% vs 6.3%, P < 0.05). Steep learning curve noted |
| Lai et al[15], 2022 | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | 259.0 minutes vs 225.0 minutes (NS) | 400.0 vs 366.7 mL (NS) | Not reported | Lower screw loosening rate with RA (4.3% vs 10.2%, P = 0.049). Similar complication rates (24.1% both groups). RA screws placed closer to upper endplate (P < 0.001) |
| Zhang et al[20], 2019 | Gertzbein-Robbins | 93.2% | 85.8% | P = 0.02 | 98.3% vs 93.6% | P = 0.02 | 165.3 ± 58.9 minutes vs 154.7 ± 46.0 minutes (P = 0.349) | 187.2 ± 95.2 mL vs 373.2 ± 320.3 mL (P = 0.001) | Dose: 25.9 ± 14.2 μSv vs 70.5 ± 27.3 μSv (P < 0.001) time: 93.5 ± 37.9 seconds vs 70.5 ± 28.3 seconds (P = 0.002) | Fewer facet violations: 5 vs 24 screws (P = 0.001). Lower revisions: 0 (RA) vs 2 (FG). Learning curve noted for RA (longer setup time) |
| Zhang et al[21], 2019 | Gertzbein-Robbins | 85.0% | 71.0% | P = 0.017 | 98.0% vs 94.0% | NS | 184.7 minutes vs 117.8 minutes (P < 0.001) | 171.6 vs 362.0 mL (P = 0.001) | 30.3 vs 65.3 μSv (P < 0.001) | Longer op time but less radiation in RA |
| Chen et al[22], 2021 | Gertzbein-Robbins | 92.3% | 77.4% | P < 0.001 | 98.6% vs 96.6% | NS | 169.67 minutes vs 135.48 minutes (P < 0.001) | 92 vs 261 mL (P < 0.001) | 1.26 minutes vs 0.54 minutes (P < 0.001) | Longer op time but less blood loss in RA |
| Cui et al[23], 2021 | Gertzbein-Robbins | 94.6% | 85.0% | P = 0.025 | 100% vs 100% | NS | RA MIS-TLIF: 135.1 ± 11.2 minutes. Open TLIF: 102.2 ± 7.1 minutes (P = 0.002) | RA MIS-TLIF: 173.6 ± 17.9 mL open TLIF: 332.1 ± 23.5 mL (P = 0.005) | Not reported | RA MIS-TLIF showed longer operative time (learning curve) but significantly reduced blood loss and postoperative drainage (97.5 mL vs 261.3 mL, P < 0.001). Faster recovery: Shorter hospitalization (7.3 days vs 10.0 days) and time to ambulation (1.5 days vs 2.9 days, P < 0.05). Less muscle atrophy: Paraspinal muscle cross-sectional area decreased by 3.9% (vs 14.5% in open TLIF, P = 0.016) |
| Feng et al[24], 2020 | Gertzbein-Robbins | 98.2% | 93.1% | P = 0.039 | 100% vs 99.4% | NS | 196.25 minutes vs 230.63 minutes (P < 0.05) | 165 mL vs 237.5 mL (P < 0.05) | Not reported | Efficiency benefit with RA |
| Li et al[25], 2024 | Gertzbein-Robbins | 87.5% | 70.1% | P < 0.001 | 98.3% vs 96.9% | NS | 158.5 minutes vs 146.4 minutes (P < 0.001) | 58.5 vs 52.8 (NS) | Surgeon: 13.8 vs 74.7 fluoroscopy counts (P < 0.001) | Longer operative time in RA but reduced surgeon radiation exposure. Lower adjacent segment degeneration (0.63 mm vs 0.92 mm height loss, P = 0.001) |
| Han et al[26], 2021 | Gertzbein-Robbins | 92.9% | 90.9% | NS | 97.3% vs 96.2% | NS | OLIF: 164.9 ± 56.0 minutes MIS-TLIF: 121.5 ± 48.2 minutes (P < 0.01) | OLIF: 142.4 ± 89.4 mL MIS-TLIF: 291.5 ± 72.3 mL (P < 0.01) | Not reported | OLIF had significantly longer operative time but less blood loss. OLIF required position change (lateral to prone), contributing to longer time |
| De Biase et al[27], 2021 | Gertzbein-Robbins | 97.4% | 93.9% | NS | 99.8% vs 99.3% | NS | 241 minutes vs 246 minutes (NS) | 73.8 mL vs 73.9 mL (NS) | 31.5 vs 59.5 mGy (P = 0.035) | RA reduced radiation |
| Fayed et al[28], 2020 | Gertzbein-Robbins | 94.2% | 96.7% | NS | 98.1% vs 100% | NS | Not reported | Not reported | Not reported | RA-PPS: 5.8% breach rate (6/103 screws), with 1.9% significant breaches (> 2 mm). FG-PPS: 3.3% breach rate (3/90 screws), with 1.1% significant breaches. Learning curve: 5 breaches in first 48 screws (10 cases) vs 1 breach in next 55 screws (10 cases). Lateral breaches (4/6) linked to facet hypertrophy/skiving |
| Yang et al[29], 2019 | Gertzbein-Robbins | 93.8% | 73.8% | P = 0.012 | 98.5% vs 96.9% | NS | Not reported | Not reported | Not reported | The study focused on accuracy (pedicle screw placement) and facet joint violation, not perioperative efficiency metrics. RA group had significantly lower pedicle wall penetration (6.2% vs 26.2%) and facet joint violation (5.1% vs 15.6%) compared to FG group. No severe deviations (Neo grade III) in RA group |
| Schatlo et al[30], 2014 | Gertzbein-Robbins | 83.6% | 79.8% | NS | 91.4% vs 87.1% | NS | 205 minutes vs 189 minutes (NS) | 375 mL vs 713 mL (P < 0.01) | Not reported | Lower blood loss in RA |
| Li et al[31], 2024 | Gertzbein-Robbins | 96.3% | 95.0% | P < 0.05 | A: 99%, B: 98%, C: 91% | P < 0.05 | A: 146.9 ± 10.8, B: 172.5 ± 13.2, C: 169.0 ± 13.6 (A < B/C, P < 0.05) | A: 89.3 ± 11.3, B: 74.4 ± 14.6, C: 111.6 ± 20.9 (B < A < C, P < 0.05) | Significantly lower in A/B vs C (P < 0.05) | Group A had shortest operation time. Group B had least blood loss. Group C had highest radiation exposure |
| Li et al[32], 2022 | Gertzbein-Robbins | 99.24% | 91.03% | P = 0.002 | Not specifically reported in A + B form, but grade A alone was 99.24% in RA | Not explicitly reported for A + B, only for grade A | 154.75 ± 7.32 vs 172.22 ± 14.82 (P = 0.001) | 89.49 ± 18.63 vs 121.48 ± 20.55 (P = 0.001) | Fluoroscopy: 59.54 ± 6.56 vs 70.67 ± 9.70 (P = 0.001) | Robot group had shorter hospital stays (3.86 ± 1.17 days vs 5.03 ± 0.73 days) |
- Citation: Ardila CM, Ángel-Estrada S, González-Arroyave D. Robot-assisted vs conventional lumbar interbody fusion: A systematic review and meta-analysis of perioperative, radiographic, and clinical outcomes. World J Orthop 2025; 16(11): 110276
- URL: https://www.wjgnet.com/2218-5836/full/v16/i11/110276.htm
- DOI: https://dx.doi.org/10.5312/wjo.v16.i11.110276