European Spine Journal - 2026-04-12 - Journal Article
Thoracolumbar burst fractures: robot-assisted mono-segment fixation with vertebral body grafting versus short-segment fixation - a propensity score-matched cohort study.
Qiao J, Fan Y, Zhao R, Lv X, Fang X
Topics
Key Takeaway
Robot-assisted mono-segment fixation with vertebral body grafting achieved equivalent 12-month sagittal Cobb angle correction (mean difference -0.07°, 95% CI within ±2.0° MCID) versus short-segment fixation while reducing operative time by 27 minutes and blood loss by 44 mL.
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Summary
This single-center retrospective propensity score-matched study compared robot-assisted mono-segment pedicle screw fixation with vertebral body grafting (RMF-VBG) to conventional short-segment fixation with grafting (SF-VBG) in neurologically intact (ASIA E) AO-A3 thoracolumbar burst fractures at T11-L2. RMF-VBG demonstrated superior perioperative metrics including shorter operative time (62 vs 90 min), less blood loss (83 vs 126 mL), and shorter postoperative LOS (5.2 vs 7.2 days), all p<0.001. Sagittal Cobb angle loss at 12 months was equivalent between groups (mean difference -0.07°), with Grade A screw accuracy higher in the robotic group (98.35% vs 90.13%) and zero facet joint violations versus 3.95% in the conventional group.
Key Limitation
Twelve-month follow-up is insufficient to determine whether the reduced implant density of mono-segment fixation leads to higher rates of late correction loss, hardware failure, or need for revision compared to short-segment constructs.
Original Abstract
PURPOSE
To compare robot-assisted mono-segment pedicle fixation with vertebral body grafting (RMF-VBG) versus conventional short-segment fixation with grafting (SF-VBG) for neurologically intact thoracolumbar burst fractures, focusing on radiographic maintenance of correction and perioperative efficiency.
METHODS
We performed a single-center retrospective cohort study (2018-2022) including adults with single-level AO-A3 fractures (T11-L2), ASIA E, treated within 14 days. One-to-one propensity score matching balanced baseline factors. The primary endpoint was loss of sagittal Cobb angle (SCA) at 12 months. Secondary outcomes included operative time, blood loss, postoperative length of stay (postop LOS), pain (VAS), Oswestry Disability Index (ODI), anterior vertebral body height ratio (AVBHr), pedicle screw accuracy (Gertzbein-Robbins), facet joint violation (FJV), perioperative morbidity and adjacent segment degeneration (ASD).
RESULTS
A total of 152 patients were matched (76 per group). RMF-VBG achieved significantly shorter operative time (62.38 ± 14.26 vs 89.56 ± 20.36 min), reduced blood loss (82.54 ± 19.69 vs 126.38 ± 28.26 mL), and shorter postop LOS (5.23 ± 1.72 vs 7.16 ± 1.39 days; all p<0.001). SCA and AVBHr trajectories were comparable; SCA loss at 12 months did not differ (mean difference -0.07°, 95% CI -0.30 to 0.16; p = 0.551). The 95% CI for the between-group difference in 12-month SCA loss remained within the ±2.0° MCID, indicating no clinically important difference. Screw placement accuracy (Grade A) was higher with RMF-VBG (98.35% vs 90.13%), and FJV Grade 2 was less frequent (0% vs 3.95%). Overall morbidity and ASD were uncommon and similar between groups.
CONCLUSION
For selected thoracolumbar burst fractures, RMF-VBG maintained sagittal correction within the prespecified MCID compared with SF-VBG, while improving perioperative efficiency and screw-related precision.