©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 4 Clinical and patient-reported outcomes
| Ref. | VAS/ODI improvement | Revision rate (RA vs comparator) | Fusion success | Notes |
| Wang et al[1], 2023 | VAS back: Pre-op 6.92 → 0.90 (RA), 6.78 → 0.71 (FA) at 2 years (P > 0.05) | RA: 1 lateral wall violation (adjusted intraoperatively) | RA: 88.5% (BSF-3) | RA showed fewer facet violations (P < 0.001) |
| VAS leg: Pre-op 7.70 → 0.54 (RA), 7.56 → 0.44 (FA) (P > 0.05) | FA: 1 anterior vertebral perforation (abdominal pain), 1 nerve root irritation (required revision) | FA: 85.5% (BSF-3) (P > 0.05) | Less disc height loss at adjacent segments in RA (P < 0.001) | |
| ODI: Pre-op 70.90 → 15.23 (RA), 71.00 → 14.89 (FA) (P > 0.05) | ||||
| Tong et al[2], 2024 | VAS-back: Significantly lower in robot group at 3 days post-op (2.19 vs 3.18, P < 0.05); no difference at 3/6 months | 1 case vs 1 case | Not reported | No complications like infection or dural tear reported in either group |
| VAS-leg: No significant difference at any time point | ||||
| ODI: No significant difference at any time point | ||||
| Shafi et al[3], 2022 | Not reported | RA: No high-grade breaches (grade E) | Not reported | Higher facet violations in RN (5.0% vs 1.3%, P < 0.001), but no clinically significant breaches |
| ION: 1.2% high-grade breaches (17 screws, P = 0.05) | ||||
| Griepp et al[4], 2024 | ODI: Significant improvement in both groups at 6mo (Δ18.6 robot vs Δ18.2 fluoroscopy) and 12mo (Δ20.7 vs Δ22.4), with similar MCID achievement rates (P > 0.05). NRS back pain: Significant improvement in both groups at 6 months (Δ2.8 vs Δ2.3) and 12 months (Δ2.6 vs Δ2.8), with no inter group differences (P > 0.05) | RA: 1 revision (infection-related hardware removal). Fluoroscopy group: 3 revisions (2 infections, 1 foraminotomy) | High | Low rates in both groups (4.9% overall), with no neurological injuries |
| Screw malposition: 0 revisions in both groups | ||||
| Lin et al[5], 2022 | Similar (P > 0.05) | RA: 1.3% intraop (K-wire malposition), 4.0% postop (CSF leak, wound infection) FG: 1.3% intraop (durotomy), 4.0% postop (screw malposition, wound infection) (P = 0.99 for postop surgery-related complications) | Not reported | RA reduced pedicle breaches (0.27% vs 1.75%, P = 0.04) and blood loss (P = 0.019) |
| Li et al[6], 2025 | VAS-back: 6.3 → 1.8 (RA) vs 6.1 → 1.7 (traditional) | 0% (RA) vs 0.9% (traditional) | 90.3% vs 85.7% grade I | RA: 4 paresthesias; traditional: 2 paresthesias |
| ODI: Comparable at 2 years | ||||
| Heath et al[7], 2024 | VAS/ODI: Not explicitly reported in the study. Clinical safety was confirmed by maintained neurological status postoperatively | RA: 0 revisions for screw malposition. Navigation group: 0 revisions for screw malposition | High (no difference) | No medial breaches or neurological complications in either group |
| Chang et al[11], 2022 | VAS for back pain: Better in PE RA-TLIF (1.3 ± 0.4) vs MIS-TLIF (2.1 ± 0.1), P < 0.05.ODI: No significant difference (17 ± 5 vs 21 ± 8, P = 0.09) | No revisions reported. Misplacement rate: 0.9% (PE RA-TLIF) vs 6.3% (MIS-TLIF), P < 0.05 | Fusion rate: 87.3% (PE RA-TLIF) vs 91.8% (MIS-TLIF), P = 0.53 | PE RA-TLIF showed reduced surgical trauma and faster recovery |
| Lai et al[15], 2022 | VAS-leg/back and ODI (preop to 12-month): VAS-leg: Preop 8.0 → 0.0 (Ro) vs 0.0 (FG) VAS-Back: Pre-op 8.0 → 2.0 (Ro) vs 3.0 (FG) ODI: Pre-op 57.78 → 26.67 (Ro) vs 28.89 (FG) (all P < 0.05 for improvement; no intergroup differences) | Complications: RA TLIF: 24.1% (7/29): 3 screw loosening, 3 cage subsidence, 2 infections. FG TLIF: 24.1% (19/79): 14 screw loosening, 2 cage subsidence, 3 infections | Not reported | Less screw loosening in RA (P = 0.049) |
| Revisions: 1 broken rod (FG TLIF) | ||||
| Zhang et al[20], 2019 | Not reported | RA: 0% (0/176 screws) | Not reported | FJV: RA-PPS: 5 screws vs FG-PPS: 24 screws (P = 0.001) |
| Comparator: 1.0% (2/204 screws) | Blood loss: Reduced in RA group (187.2 mL vs 373.2 mL, P = 0.001 | |||
| Zhang et al[21], 2019 | Not reported | RA: 0% (0/100 screws); FG: 1% (1/100 screws) | Not reported | FJV: RA: 4% (4/100) vs FG: 26% (26/100) (P = 0.0001) |
| Severe FJV (grade 3): Only in FG group (3 screws) | ||||
| Intra-pedicle accuracy (grade A): RA: 85% vs FG: 71% (P = 0.017) | ||||
| Blood loss: RA: 171.6 mL vs FG: 362.0 mL (P = 0.001) | ||||
| Chen et al[22], 2021 | Similar (P > 0.05) | None | 94.2% vs 92.3% (NS) | RA showed shorter hospital stay |
| Cui et al[23], 2021 | VAS: 6.9 → 2.1 (RA) vs 6.5 → 3.7 (open) (P = 0.004); ODI: Comparable at 2 years | 0% (RA) vs 5% (open) | Comparable | RA: 1 transient numbness; open: 1 screw loosening |
| Feng et al[24], 2020 | VAS back pain: Immediate post-op: 2.15 (RA) vs 3.35 (comparator) (P < 0.05) ODI: No significant difference between groups at any time point | RA: 0.01% (1/170 screws) comparator: 3.4% (6/174 screws) | Not reported | RA group had shorter operative time, less blood loss, and no postoperative drainage |
| Complications: RA (1 hip flexor weakness); comparator (1 infection, 1 hip flexor weakness, 1 delayed wound healing) | ||||
| Li et al[25], 2024 | VAS-back/Leg: No significant difference between groups pre-op, post-op 3 days, or final follow-up (P > 0.05). ODI: No significant difference at any time point (P > 0.05) | RA: 1 screw revision (penetrated outer pedicle wall, adjusted intraoperatively). Freehand group: 2 screws revised (penetrated anterior cortex, causing transient abdominal pain; 1 screw irritated nerve root, requiring immediate revision) | No significant difference in fusion status (BSF grading) between groups (P > 0.05) | Lower FJV in robot group (0.13 grades vs 0.43 grades, P < 0.001). Less adjacent segment disc height loss in robot group (0.63 mm vs 0.92 mm, P = 0.001) |
| Han et al[26], 2021 | VAS back pain: Lower in OLIF at 1 week (2.8 vs 3.5, P < 0.05) and 3 months (1.6 vs 2.1, P < 0.05). ODI: Lower in OLIF at 3 months (22.3 vs 26.1, P < 0.05) - no differences in leg pain VAS | No revisions reported.Complications: OLIF (7/28) vs MIS-TLIF (5/33), all resolved conservatively | Fusion rate: Higher in OLIF (96% vs 87%, P < 0.01). Disc height: Greater in OLIF (12.4 mm vs 11.2 mm, P < 0.01 | Higher fusion in OLIF with RA OLIF had less blood loss (142.4 vs 291.5 mL, P < 0.01) and shorter hospital stays (3.2 vs 4.2 days, P < 0.01) |
| De Biase et al[27], 2021 | Not reported | Revisions: 1/52 (RA, pseudoarthrosis) vs 2/49 (FG, no surgery required) | Fusion status: No significant differences (pseudoarthrosis rates: 2% RA vs 4% FG, P = 0.523). | Lower radiation in RA group. Operative time, blood loss, hospital stay, and complication rates were similar |
| Fayed et al[28], 2020 | Not reported | RA: 0% (0/103 screws); comparator: 1.1% (1/90 screws) | Not reported | Complications: No revisions required in RA-PPS group; 1 revision in FG-PPS group (medial breach) |
| Yang et al[29], 2019 | Not reported | RA: 0% (0/130 screws); comparator: 3.1% (4/130 screws) | Not reported | FJV: RA-PPS: 5.1% (5/98 screws); FG-PPS: 15.6% (15/96 screws) (P = 0.021) |
| Complications: No severe facet violations (Babu grade III) in RA-PPS group; 2 cases in FG-PPS group | ||||
| Schatlo et al[30], 2014 | Not reported | Robot-assisted: 2.5% (6/244 screws revised intraoperatively); FG: 1 revision surgery (for radiculopathy due to screw malposition) | Not reported | Neurological injury occurred in 1 FG case (resolved after revision) |
| No significant difference in infection rates (robot: 1.8%, fluoroscopy: 2.5%) | ||||
| Blood loss was significantly lower in the robot-assisted group | ||||
| Li et al[31], 2024 | Significant improvement at 6 months (P < 0.05), no difference between groups (P > 0.05) | A: 0, B: 0, C: 0 | Not reported | Macnab excellent/good rates: A: 96%, B: 93%, C: 92% (P > 0.05). No difference in complications (P > 0.05) |
| Li et al[32], 2022 | No significant difference between groups (P > 0.05) | 0/33 vs 2/39 (screw reinsertion) | Not reported | Macnab excellent rate: 91% (RA) vs 87% (conventional group), P = 0.900. Complications: 9% vs 20% |
- 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