Objective This study aimed to compare the clinical outcomes of patients with AOSpine A3 or A4 thoracolumbar fractures presenting with neurological deficits treated with endoscopic decompression combined with percutaneous pedicle screws fixation (endoscopic minimally invasive surgery, EMIS) or conventional open surgery (OS).
Methods Data of patients with AOSpine A3 or A4 thoracolumbar fractures with neurological deficits who were treated with EMIS or OS between June 2019 and July 2021 were extracted from the electronic database. Various clinical outcomes were compared between the 2 cohorts.
Results Among the 231 patients who were followed up for more than 2 years, 107 were in the EMIS cohort and 124 were in the OS cohort. Compared with the OS cohort, the EMIS cohort had longer operative time (p<0.05), but the intraoperative blood loss, incision length and hospital stay were significantly reduced (p<0.05). At both postoperative and final follow-up assessments, the EMIS cohort demonstrated significantly better visual analogue scale and Oswestry Disability Index outcomes compared to the OS cohort (p<0.05). Both cohorts maintained similar correction of spinal canal erosion rate, percentage of anterior vertebral height and sagittal Cobb angle after surgery and at the last follow-up (p>0.05). According to American Spinal Injury Association classification, the 2 cohorts had similar neurological recovery at the last follow-up (p>0.05).
Conclusion In comparison to OS, EMIS treatment for AOSpine A3 or A4 thoracolumbar fractures with neurological deficits has shown comparable clinical efficacy while significantly reducing surgical trauma.
Citations
Citations to this article as recorded by
Severe trauma care: advances and future directions in diagnostic and therapeutic techniques and information technology support Feifei Jin, Shu li, Xuemin Zhang, Wei Huang, Jing Zhou, Zhongdi Liu, Pan Hu, Yanqiu Wu, Zixiao Zhang, Lijun Hou, Xiangjun Bai, Tianbing Wang Medical Review.2026; 6(3): 175. CrossRef
With the development of artificial intelligence and the further deepening of medical-engineering integration, spine surgical robot-assisted (RA) technique has made significant progress and its applicability in clinical practice is constantly expanding in recent years. In this review, we have systematically summarized the majority of literature related to spine surgical robots in the past decade, and not only classified robots accordingly, but also summarized the latest research progress in RA technique for screw placement such as cervical, thoracic, and lumbar pedicle screws, cortical bone trajectory screws, cervical lateral mass screws, and S2 sacroiliac screws; guiding targeted puncture and placement of endoscope via the intervertebral foramen; complete resection of spinal tumor tissue; and decompressive laminectomy. In addition, this report also provides a detailed evaluation of RA technique’s advantages and disadvantages, and clarifies the accuracy, safety, and practicality of RA technique. We consider that this review can help clinical physicians further understand and familiarize the current clinical application status of spine surgical robots, thereby promoting the continuous improvement and popularization of RA technique, and ultimately benefiting numerous patients.
Citations
Citations to this article as recorded by
A decade of progress in orthopaedic telesurgery from concept to clinical feasibility: an evidence based review of robotics, latency science, digital ecosystems, and future remote surgical practice Gaurav Jha, Tharshan Sivakanthan, Gagandeep Mahi, Amit Bishnoi Journal of Robotic Surgery.2026;[Epub] CrossRef
Extended uses of robots in spine surgery beyond thoracolumbar pedicle screws: A narrative review Vidyadhara Srinivasa, Abhishek Soni, Balamurugan Thirugnanam, Prabhu Krishnan Journal of Robotic Surgery.2026;[Epub] CrossRef
Robot-assisted versus conventional fluoroscopy-guided percutaneous pediculoplasty for symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture without neurological deficits Xinliang Zhang, Huiming Yang, Jiangtao Wang, Liang Yan, Junxian Miao, Guanying Li, Dingjun Hao, Biao Wang BMC Geriatrics.2026;[Epub] CrossRef
Mechanized precision: the rise of robotic systems in spinal surgery Vicron Mickelet, Ayla Yagdiran, Mohamad Agha Mahmoud, Maher Ghandour, Filip Milicevic, Koroush Kabir, Ümit Mert Die Orthopädie.2026;[Epub] CrossRef
Robot-Assisted “Postage-Stamp” Vertebrotomy for Spinal Tumor Resection: Case Report Carlo Brembilla, Gabriele Capo, Mario De Robertis, Umberto Cariboni, Ali Baram, Donato Creatura, Emanuele Stucchi, Leonardo Anselmi, Federico Pessina, Maurizio Fornari Journal of Clinical Medicine.2026; 15(11): 4268. CrossRef
Robot-Assisted Spine Surgery: The Pearls and Pitfalls Nathan J. Lee, Joseph M. Lombardi, Sheeraz Qureshi, Ronald A. Lehman Journal of the American Academy of Orthopaedic Surgeons.2025; 33(2): e81. CrossRef
Design and Accuracy Assessment of NOR²CORS: Navigation-Operation Dual-Robot Collaborative Robotic System for Orthopedic Surgery Pengxiu Geng, Mengde Luo, Jianpeng Liu, Tianyao Li, Hongpeng Wang, Yanding Qin, Jianda Han IEEE Transactions on Medical Robotics and Bionics.2025; 7(2): 502. CrossRef
Endoscopic Decompression Combined With Percutaneous Pedicle Screw Fixation for AOSpine A3 or A4 Thoracolumbar Fractures With Neurological Deficits: A Retrospective Cohort Study Huiming Yang, Junxian Miao, Jiangtao Wang, Dan Han, Yuhang Wang, Liang Yan, Biao Wang, Dingjun Hao Neurospine.2025; 22(2): 571. CrossRef
The application of robotic and artificial intelligence technologies in spinal surgery: a review focused on prospects in remote areas of China Zhibin Liu, Junlong Huang, Hao Zhang, Shuzhuo Zhang, Honghao Dai, Yuexin Jiang, Hongtao Bi, Zhongshu Shan Journal of Robotic Surgery.2025;[Epub] CrossRef
Intelligence Architectures and Machine Learning Applications in Contemporary Spine Care Rahul Kumar, Conor Dougherty, Kyle Sporn, Akshay Khanna, Puja Ravi, Pranay Prabhakar, Nasif Zaman Bioengineering.2025; 12(9): 967. CrossRef
Artificial intelligence in the context of the surgical treatment of scoliosis in adults, with an emphasis on applications, outcomes, and ethical implications: A systematic review Jheremy Sebastian Reyes-Barreto, María Alejandra Rodríguez-Brilla Revista Colombiana de Ortopedia y Traumatología.2025; 39: e542. CrossRef
Design of a Patient-Specific Needle Insertion Device for Accurate and Safe Lumbar Puncture Wenbo Jia, Teng Wang, Baohua Zhao, Wenzhuo Huang, Yuzhou Duan, Zuoqing Yu, Jie Ling Journal of Mechanisms and Robotics.2025;[Epub] CrossRef
A comparative analysis of three distinct approaches for the management of type A1 traumatic thoracolumbar fractures: a retrospective cohort study with a minimum 6-year follow-up Jiangtao Wang, Huiming Yang, Mario Ganau, Yuhang Wang, Junxian Miao, Liang Yan, Biao Wang Journal of Orthopaedic Surgery and Research.2025;[Epub] CrossRef
Risk factors of inaccurate screw placement in robotic spine surgeries: why do robots make error and how to avoid them? S. Vidyadhara, R Dinesh Iyer, Abhishek Soni, T. Balamurugan, Dhiyanesh Krishnamurthy Journal of Robotic Surgery.2025;[Epub] CrossRef
Robotic versus conventional single-level lumbar fusion in frail older adults: analysis of the National Readmission Database, 2016–2020 Po-Wen Chen, Tsung-Hsi Yang, Tao-Chieh Yang, Se-Yi Chen Journal of Orthopaedics and Traumatology.2025;[Epub] CrossRef
Development of a software system for surgical robots based on multimodal image fusion: study protocol Shuo Yuan, Ruiyuan Chen, Lei Zang, Aobo Wang, Ning Fan, Peng Du, Yu Xi, Tianyi Wang Frontiers in Surgery.2024;[Epub] CrossRef
Evaluating the Status and Promising Potential of Robotic Spinal Surgery Systems Xiang Li, Jiasheng Chen, Ben Wang, Xiao Liu, Shuai Jiang, Zhuofu Li, Weishi Li, Zihe Li, Feng Wei Orthopaedic Surgery.2024; 16(11): 2620. CrossRef
First
Prev
