Global Spine Journal - 2026-03-10 - Journal Article
Impact of Navigation Modality on Radiographic Parameters Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.
Hahn ZC, Asada T, Boyle R, Halayqeh S, Lui ATH, Pezzi A, Durbas A, Tuma OC, Giattino NJ, Lewis AR, Sheha ED, Lovecchio FC, Huang RC, Sandhu H, Dowdell JE, Qureshi SA, Iyer S
Topics
Key Takeaway
Robotic-assisted MI-TLIF achieved 71.6% disc height improvement vs 22.5% with imaging-only navigation, while navigation produced greater lumbar lordosis restoration, with preoperative LL independently predicting postoperative LL (β=0.64).
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Summary
This single-center retrospective study compared robotic-assisted vs imaging-only navigation in one-level MI-TLIF for degenerative spondylolisthesis, assessing radiographic parameters at 6 months. The robotic group achieved significantly greater disc height restoration (71.6% vs 22.5%, P=0.002) and used larger screws and more expandable cages, while the navigation group achieved greater lumbar lordosis restoration (P=0.006). Preoperative LL was the dominant independent predictor of postoperative LL (β=0.64, P<0.001), and no differences in slip reduction or cage subsidence were detected.
Key Limitation
Implant selection (expandable vs static cages, screw diameter) was not standardized between groups, making it impossible to isolate the effect of navigation modality from surgeon-directed hardware choices.
Original Abstract
Study DesignSingle-center, retrospective cohort review.ObjectiveThis study aims to compare the impact of robotic and imaging-only navigation modalities on radiographic parameters following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).MethodsPatients with degenerative spondylolisthesis who underwent one-level MI-TLIF using navigation or robotic modalities were included and divided into two groups: robotic-assisted (Robo) or imaging-only navigation (Nav). Radiographic parameters were assessed preoperatively and 6 months postoperatively. Outcome measures were screw and cage characteristics, postoperative disc height (DH) improvements, lumbar lordosis (LL), and slip reduction rates. Statistical analyses included paired and independent samples t-tests and multivariable linear regression analysis.ResultsThe Robo group often used larger screw diameters, deeper cages, and more expandable cages, while the Nav group used wider cages. The Robo group demonstrated significantly greater DH improvement compared to the Nav group (average improvement: 71.6% vs 22.5%, P = 0.002). However, the Nav group showed significantly greater LL restoration than the Robo group ( P = 0.006), and preoperative LL was independently associated with postoperative LL (β = 0.64, P < 0.001). No clear differences in slip reduction or cage subsidence were observed.ConclusionsIn MI-TLIF, robotic guidance was associated with greater DH restoration and the use of larger screws, whereas LL restoration appeared to depend mainly on preoperative sagittal alignment and was greater with image-guided navigation. These findings suggest that each modality can be leveraged to optimize different radiographic goals and underscore the need for studies integrating implant strategies with clinical outcomes.