Robotic-assisted kyphoplasty demonstrates superior efficacy, safety, and procedural efficiency compared to fluoroscopy-guided techniques: a retrospective analysis of 240 patients.

Abstract

Osteoporotic vertebral compression fractures (OVCFs) are a significant health burden with increasing prevalence in the aging population. This study compares robotic-assisted kyphoplasty (RK) with conventional fluoroscopy-guided kyphoplasty (FK) for the treatment of OVCFs. A single-center retrospective study analyzed 240 patients (120 in each group) who underwent kyphoplasty for OVCFs between January 2020 and December 2022 under general anesthesia. Clinical outcomes were assessed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiological outcomes included vertebral height restoration and kyphotic angle correction. Procedural parameters including radiation exposure, procedural time, and complications were analyzed. Correlation analysis was performed to assess the impact of vertebral anatomy complexity on procedural outcomes. Both groups demonstrated significant clinical and radiological improvements with comparable pain relief and functional outcomes. The RK group showed superior vertebral height restoration (68.00% vs. 64.38%, p = 0.004) and significantly lower cement leakage rates (5.8% vs. 19.2%, p = 0.002) compared to the FK group. Radiation exposure was significantly lower in the RK group (18.76 mGy vs. 22.69 mGy, p < 0.00001). Total procedure time was significantly shorter in the RK group (50.91 min vs. 86.40 min, p < 0.00001). Correlation analysis revealed that thoracic level complexity affected both techniques similarly, with significant correlations between thoracic levels and increased radiation exposure and procedural time in both groups. However, the robotic group maintained superior absolute performance regardless of anatomical complexity. Robotic-assisted kyphoplasty provides superior safety profiles with reduced cement leakage and radiation exposure, better vertebral height restoration, and shorter procedural times compared to fluoroscopy-guided techniques. Importantly, these advantages persist across different levels of anatomical complexity, suggesting that robotic assistance offers consistently superior performance regardless of case difficulty. These findings support the adoption of robotic-assisted techniques for treating OVCFs.