Navigation-assisted vs robot -assisted unilateral biportal endoscopic lumbar interbody fusion for single-level lumbar degenerative disease: a retrospective comparative study.

Abstract

Introduction: Lumbar degenerative disease (LDD) is increasingly common, and causes back and leg pain that impairs quality of life. Lumbar interbody fusion (LIF) is effective for patients with neural compression and segmental instability. Unilateral biportal endoscopic LIF (UBE-LIF) allows for minimally-invasive decompression and fixation, while navigation- and robot-assisted systems improve pedicle screw accuracy and intraoperative guidance.

Aim: This study compared perioperative outcomes and clinical efficacy of navigation-assisted vs robot-assisted single-level UBE-LIF.

Materials and methods: Patients with single-level LDD who underwent navigation-assisted (Na group; n = 23) or robot-assisted (Ra group; n = 29) UBE-LIF between January 2020 and December 2024 were retrospectively enrolled. Clinical outcomes were assessed using the Numeric Rating Scale, Oswestry Disability Index, and modified MacNab criteria. Pedicle screw placement and radiological parameters, including disc height, lumbar lordosis, and segmental lumbar lordosis, were evaluated, and IF was assessed at 12 months postoperatively.

Results: Endoscopic operative time was shorter in the Na group than in the Ra group (116.74 vs 127.86 min; P = 0.03), whereas screw insertion time and pedicle screw placement were superior in the Ra group (39.55 vs 46.52 min; P = 0.001 and 98.5% vs 92.4%; P = 0.04, respectively). Both groups showed comparable improvements in clinical outcomes, radiological parameters, and fusion rates, with similarly low complication rates.

Conclusions: Navigation- and robot-assisted UBE-LIF are safe and effective procedures. Robot-assisted surgery offers higher screw accuracy and faster insertion, while the navigation-assisted approach reduces endoscopic operating time. Clinical outcomes and fusion rates between the 2 techniques are similar.