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 [DOI: 10.5312/wjo.v16.i11.110276]
Corresponding Author of This Article
Carlos M Ardila, Postdoctoral Fellow, Professor, Senior Researcher, Department of Basic Sciences, Biomedical Stomatology Research Group, Faculty of Dentistry, Universidad de Antioquia, Calle 70 No. 52-21, Medellin 050010, Antioquia, Colombia. martin.ardila@udea.edu.co
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Orthopedics
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Systematic Reviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 18, 2025 (publication date) through Nov 20, 2025
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World Journal of Orthopedics
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2218-5836
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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 [DOI: 10.5312/wjo.v16.i11.110276]
World J Orthop. Nov 18, 2025; 16(11): 110276 Published online Nov 18, 2025. doi: 10.5312/wjo.v16.i11.110276
Robot-assisted vs conventional lumbar interbody fusion: A systematic review and meta-analysis of perioperative, radiographic, and clinical outcomes
Carlos M Ardila, Santiago Ángel-Estrada, Daniel González-Arroyave
Carlos M Ardila, Department of Basic Sciences, Biomedical Stomatology Research Group, Faculty of Dentistry, Universidad de Antioquia, Medellin 050010, Antioquia, Colombia
Carlos M Ardila, Department of Periodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India
Santiago Ángel-Estrada, Department of Neurosurgery, Universidad de Antioquia, Medellin 050010, Antioquia, Colombia
Daniel González-Arroyave, Department of Surgery, Universidad Pontificia Bolivariana, Medellin 050031, Antioquia, Colombia
Author contributions: Ardila CM performed the conceptualization and manuscript writing; Ardila CM, Ángel-Estrada S, and González-Arroyave D performed the data curation, data analysis, and revision of the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carlos M Ardila, Postdoctoral Fellow, Professor, Senior Researcher, Department of Basic Sciences, Biomedical Stomatology Research Group, Faculty of Dentistry, Universidad de Antioquia, Calle 70 No. 52-21, Medellin 050010, Antioquia, Colombia. martin.ardila@udea.edu.co
Received: June 3, 2025 Revised: June 12, 2025 Accepted: October 11, 2025 Published online: November 18, 2025 Processing time: 164 Days and 9.5 Hours
Abstract
BACKGROUND
Minimally invasive lumbar interbody fusion (LIF) procedures have evolved rapidly in recent years, with robot-assisted (RA) techniques increasingly integrated into clinical practice. However, questions remain regarding the relative advantages of RA over traditional fluoroscopy-guided and navigation-assisted methods in terms of perioperative, radiographic, and clinical outcomes. This systematic review synthesizes current evidence on these comparisons, focusing on the accuracy of screw placement, perioperative efficiency, radiographic and clinical outcomes, and complications.
AIM
To investigate the comparative effectiveness of RA vs conventional LIF techniques.
METHODS
A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and Cochrane guidelines. Databases searched included PubMed, EMBASE, Web of Science, Scopus, and the Cochrane Library (through May 2025). Eligible studies were randomized controlled trials and observational studies comparing RA with fluoroscopy - or navigation-guided LIF (transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, oblique lumbar interbody fusion) in adults. Two reviewers independently extracted data and assessed risk of bias. The Grading of Recommendations Assessment, Development and Evaluation framework was used to evaluate certainty of evidence. Meta-analyses were performed where data were sufficiently homogeneous.
RESULTS
Twenty-two studies were included, encompassing a total of 2313 patients - 1046 who underwent RA-guided procedures and 1267 who received comparator techniques. Meta-analyses showed that RA significantly improved perfect pedicle screw placement [pooled odds ratio = 2.93; 95% confidence interval (CI): 1.40-6.14; I2 = 78.2%] and reduced intraoperative blood loss (pooled standardized mean difference = -0.28; 95%CI: -0.47 to -0.08; I2 = 0%). Operative time did not significantly differ between groups (pooled standardized mean difference = 0.01; 95%CI: -0.30 to 0.31; I2 = 66%). Radiation dose could not be synthesized quantitatively due to heterogeneous definitions and measurement units. Narratively, RA demonstrated consistent advantages in reducing surgical exposure and adjacent segment degeneration. Clinical and radiographic outcomes, fusion success, and complication rates were generally comparable across groups.
CONCLUSION
RA LIF improves pedicle screw placement accuracy and reduces blood loss and surgeon radiation exposure while maintaining similar clinical outcomes and safety profiles to conventional techniques. These findings support the integration of RA into spine surgery but highlight the need for high-quality multicenter randomized controlled trials and cost-effectiveness studies to guide broader implementation.
Core Tip: This article confirms that robot-assisted lumbar interbody fusion significantly improves pedicle screw placement accuracy and reduces intraoperative blood loss, with no significant difference in operative time. Additionally, robot-assisted techniques offer clear advantages in reducing surgeon radiation exposure and adjacent segment degeneration. Despite these benefits, long-term clinical and fusion outcomes were comparable to those of conventional methods. These findings support the clinical precision and perioperative efficiency of robotic systems while highlighting the need for high-quality multicenter trials and cost-effectiveness analyses to inform broader implementation in spine surgery.
