Clinical Effect Analysis Of Robot-assisted Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion Combined With Facet Joint Fusion

Objective:To compare the clinical outcomes of robot-assisted percutaneous endoscopic transforaminal lumbar interbody fusion(RA-PE-TLIF),RA-PE-TLIF combined with facet joint fusion(RA-PE-TLIF+FF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of single-segment lumbar degenerative disease with instability,and to evaluate the safety and efficacy of robot-assisted lumbar fusion surgery and the feasibility of interbody fusion combined with facet joint fusion.Methods:The clinical data of 58 patients treated for single-segment lumbar degenerative disease with instability from April 2019 to April 2021 at the Department of Spine Surgery,Second Hospital of Shandong University were retrospectively analyzed,including 16 cases in the PE-RA-TLIF surgery group(Group A),20 cases in the PERA-TLIF+FF surgery group(Group B),and 22 cases in the MIS-TLIF surgery group(Group C).Perioperative data such as operative time,intraoperative blood loss,postoperative drainage,postoperative bed rest,and postoperative hospital stay were recorded and analyzed.The VAS score,ODI score,and modified Macnab criteria score were used for clinical efficacy evaluation.All patients underwent postoperative CT scans to assess fusion,screw accuracy,and the incidence of facet joint invasion(FJV).Intraoperative and postoperative complications were recorded and compared among the three groups.Results:All patients were followed up.The operative time was significantly longer in both groups A and B than in group C(P<0.05).The estimated intraoperative bleeding,postoperative drainage,postoperative bed rest time,and postoperative hospital stay were significantly lower than those in group C(P<0.05).Low back pain VAS scores and leg pain VAS scores and ODI scores were significantly improved in all three groups of patients at each postoperative follow-up time compared with preoperative scores(P<0.05).The VAS scores of low back pain were significantly lower in both groups A and B than in group C at 3 days after surgery(P<0.05),while there was no significant difference between groups A and B(P>0.05).There was no statistically significant difference in leg pain VAS scores and ODI scores among the three groups at each postoperative follow-up time period(P>0.05).There was no significant difference in the modified Macnab criteria scores at 12 months postoperatively among the three groups(P=0.810).The fusion rate of facet joint fusion and interbody fusion rate in group B at 3 months postoperatively were 100%and 70%,respectively,with statistically significant differences(P=0.008).There was no significant difference in the interbody fusion rate between groups A and B at 3 months postoperatively(P=0.677).The interbody fusion rates at 12 months postoperatively were 90%,86.36%and 93.75%in groups A,B and C,respectively,with no statistically significant differences(P=0.760).The rate of screw grade A was significantly higher in group A and B than in group C(P=0.001),whereas there was no statistically significant difference in the acceptable rate of screws(P=0.064).The incidence of FJV in group A and B was significantly lower than that in group C(P=0.038).Postoperative lumbar lordosis angle(LL),segmental lordosis angle(SL)and pelvic incidence-lumbar lordosis(PI-LL)were significantly improved in all three groups compared with the preoperative period(P<0.001).No complications such as incisional infection,fusion collapse or displacement,screw loosening,or fracture occurred in the three groups.One patient in group B had an intraoperative dural rupture,and one patient in group C had an intraoperative injury to the exiting nerve root.Conclusion:Robot-assisted percutaneous endoscopic transforaminal lumbar interbody fusion combined with facet joint fusion is safe and effective in the treatment of lumbar degenerative diseases.Compared with MIS-TLIF,RA-PE-TLIF and RA-PETLIF+FF have the advantages of less surgical trauma and faster recovery.Robotassisted lumbar fusion is more precise and safer,significantly improving the accuracy of pedicle screw placement and reducing the risk of related complications.What’s more,facet joint fusion has a high early fusion rate,shares the pressure of the nail rod system early,and increases spinal stability.