- Design
- Randomised, assessor-blinded, single centre, 1:3 allocation
- Population
- 128 adults with lumbar degenerative disease
- Primary outcome
- Oswestry Disability Index at 2 weeks
- Effect
- Mean difference −3.27 (95% CI −5.98 to −0.56); not significant at 3 months
A single-centre, assessor-blinded trial randomised 128 patients with lumbar degenerative disease 1:3 to robot-assisted minimally invasive TLIF (32) or fluoroscopy-guided open TLIF (96).
At two weeks the Oswestry Disability Index was 3.27 points lower with robotic surgery (95% CI 0.56 to 5.98), well short of the 10-point difference the trial was powered to find, and the gap had closed by three months. Screw accuracy was higher (98.9% vs 94.5% grade A) and blood loss and hospital stay favoured the robot, but operating time was longer. Fusion rates were similar.
The trial compares two things at once — robotics and a minimally invasive approach — so it cannot say which drove the early benefit. It does not support robotic systems on clinical outcome grounds alone.
- Do not promise patients better mid-term outcomes from robotic fusion
- Expect slightly quicker early recovery and less blood loss with minimally invasive approaches
- Weigh longer operating time and equipment cost against screw accuracy gains
- Counsel that fusion rates appear similar with either technique
Why it matters
Robotic spine platforms are often justified by outcomes that this trial did not find beyond the first weeks.
Don't overread it
The comparison mixes robotics with a minimally invasive approach; the benefit cannot be attributed to the robot.
The statistics, in plain English
A 3-point Oswestry difference is below the 10 points most patients would notice. Unequal group sizes (32 vs 96) mean the robotic estimates are less precise.
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