Clinical efficacy analysis of robot-assisted same position OLIF lateral plate combined with posterior unilateral fixation in the treatment of single-segment lumbar spinal stenosis

[Abstract] Objective: To investigate the clinical efficacy of robot assisted oblique lateral interbody fusion (OLIF) with lateral steel plate and posterior unilateral fixation in the treatment of single segment lumbar spinal stenosis (LSS), and to compare it with OLIF lateral fixation and OLIF combined with posterior bilateral fixation. Method: A retrospective analysis was conducted on the clinical data of the use of robot assisted OLIF lateral steel plate combined with posterior unilateral fixation (robot group, 33 cases), OLIF lateral fixation (side group, 52 cases), and OLIF combined with posterior bilateral fixation (combination group, 45 cases) in the treatment of single segment lumbar spinal stenosis in the Orthopedics Department of the First Affiliated Hospital of Kunming Medical University from January 2020 to June 2023. The surgical time, intraoperative blood loss, fluoroscopy frequency, hospitalization time, nail placement accuracy, and complications were recorded for the three groups. The pain visual analog scale (VAS), Oswestry disability index (ODI) were evaluated before, after, and at the last follow-up.). Simultaneously perform lumbar X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) examinations to measure imaging indicators such as intervertebral disc height (IDH), intervertebral foraminal height (IFH), and cross-sectional area (CSA) at the surgical segment. Compare the differences between preoperative and postoperative time points, record complications, intervertebral fusion, and subsidence rate. Result: All patients had good internal fixation and cage position, with significant symptom relief and no occurrence of spinal cord injury or worsening of symptoms. The follow-up period was (15.2 ± 3.6) months. The surgical time of the robot group was (70.62 ± 8.99) minutes, which was longer than that of the lateral group (45.90 ± 6.09) minutes and shorter than that of the combination group (110.12 ± 8.44) minutes. The intraoperative bleeding volume of the robot group (44.27 ± 6.87 mL) was higher than that of the lateral group (33.58 ± 9.73 mL) and lower than that of the combination group (79.19 ± 10.35 mL). The intraoperative fluoroscopy frequency of the robot group was 9.49 ± 2.25 times, which was equivalent to 7.45 ± 2.02 times in the lateral group, and less than 12.24 ± 4.25 times in the combination group (P<0.05). The hospitalization time of the robot group was 9.28 ± 2.10 days, which was longer than that of the lateral group (7.95 ± 1.91 days) and shorter than that of the combination group (12 days) 49 ± 5.07 days. The nail placement accuracy of the robot group was 98.48%, significantly higher than that of the combined group at 90.55%. There was no statistically significant difference in VAS and ODI between the three groups after surgery and at the last follow-up (P>0.05), and they were all lower than before surgery (P<0.05); There was no statistically significant difference in VAS and ODI among the three groups before, after, and at the last follow-up (P>0.05). The intervertebral height, intervertebral foramen height, and dural sac area of the surgical segment at postoperative and follow-up time points were significantly increased compared to preoperative levels (P<0.05), while there was no statistically significant difference between each pairwise comparison at postoperative time points (P>0.05), indicating that OLIF indirect decompression has a clear effect. During the follow-up period, the three groups were fixed in place and stable. At the last follow-up, the interbody fusion device achieved fusion. The interbody fusion rate in the robot group was 96.97%, which was similar to that in the combination group (97.78%) and higher than that in the lateral approach group (94.23%). The incidence of complications in the robot group is 9% 1% and Joint Group 8 9% is equivalent, lower than the side road group of 15 4% (P<0.05). During the follow-up period of the three groups, the fixation was stable without any looseness or breakage. Conclusion: Robot assisted lateral OLIF combined with posterior unilateral fixation therapy for single segment LSS in the same position can effectively reduce pressure indirectly, with good stability, no need for intraoperative turning, precise nail placement, reduced intraoperative bleeding, fluoroscopy frequency, and complications. It has a minimally invasive approach throughout the entire process and is a new treatment option.