Robot-assisted unilateral biportal endoscopy for lumbar decompression， fusion，and internal fixation： A retrospective study

Abstract:

Objective To investigate the application and advantages of robot-assisted unilateral biportal endoscopy in lumbar decompression，fusion，and internal fixation by comparing it with percutaneous spinal endoscopy.Methods A retrospective analysis was performed for 26 patients who were admitted to Center for Diagnosis and Treatment of Spinal Diseases，Gansu Provincial Hospital of Traditional Chinese Medicine，from February 2021 to June 2022 and needed to undergo lumbar decompression and fusion，and according to the surgical procedure，they were divided into R-ULIF group and Endo-LIF group. The patients in the R-ULIF group were treated with robot-assisted unilateral biportal endoscopy for lumbar interbody fusion（R-ULIF），and those in the Endo-LIF group were treated with percutaneous spinal endoscopic lumbar interbody fusion（Endo-LIF）. The two groups were analyzed and compared in terms of general data，fluoroscopy frequency，time of operation，bleeding volume，length of postoperative hospital stay，excellent and good rate of screw placement，fusion rate，the incidence rate of complications，visual analogue scale（VAS） score for postoperative pain，oswestry dysfunction index（ODI） score，and MacNab efficacy evaluation standard.Results All patients completed the operation successfully. There were 13 patients（6 male patients and 7 female patients） in the R-ULIF group，with an age of （53.92±9.86） years，a course of disease of 33.0（6.1，81.0） weeks，a time of operation of （187.85±10.18） minutes，a fluoroscopy frequency of （7.92±0.95） times，an intraoperative blood loss of （54.54±4.72） mL，a length of postoperative hospital stay of 3.92±0.86 days，an accuracy rate of screw placement of 98.1%（51/52），and a fusion rate of 92.3%，and no complication was observed（0%）； there were 13 patients（5 male patients and 8 female patients） in the Endo-LIF group，with an age of 52.38±10.89 years，a course of disease of 48.0（6.0，120.0） weeks，a time of operation of （175.15±23.81） minutes，a fluoroscopy frequency of 13.77±1.48 times，an intraoperative blood loss of （104.31±6.81） mL，a length of postoperative hospital stay of （5.23±1.01） days，an accuracy rate of screw placement of 76.92%（40/52），and a fusion rate of 84.6%，and the incidence rate of complications was 15%（one male patient had dural tear and one female patient had fusion cage sinking）. Compared with the Endo-LIF group，the R-ULIF group had significantly lower fluoroscopy frequency and intraoperative blood loss and a significantly shorter length of postoperative hospital stay（P<0.05）. Both groups had significant reductions in VAS score and ODI score at each time point（P<0.05），and the R-ULIF group had a better ODI score than the Endo-LIF group at 1 and 3 months after surgery（P=0.017 and 0.047），while there was no significant difference between the groups before surgery and at 1 week after surgery（P>0.05）. Based on the MacNab efficacy evaluation standard at 6 months after surgery，there were 9 cases with excellent efficacy，2 cases with good efficacy，1 case with moderate efficacy，and 1 case with poor efficacy in the R-ULIF group，with an excellent and good rate of 84.6%；in the Endo-LIF group，there were 7 cases with excellent efficacy，3 cases with good efficacy，2 cases with moderate efficacy，and 1 case with poor efficacy，with an excellent and good rate of 76.9%.Conclusion Robot-assisted unilateral biportal endoscopy for lumbar decompression，fusion，and internal fixation has a safe and reliable short-term clinical in the treatment of lumbar disc herniation combined with lumbar instability，with a high success rate of screw placement，low radiation exposure，low intraoperative blood loss，and a short length of hospital stay，and therefore，it holds promise for clinical application. In the treatment of lumbar disc herniation combined with lumbar instability.