Decker Isabella, Bakhaidar Mohamad, Shabana Summer, Boukhiam Meriem, Zani Sabino, Abd-El-Barr Muhammad
Department of Neurosurgery, Duke Health, Duke University, Durham, NC, USA.
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
BMC Surg. 2025 May 21;25(1):219. doi: 10.1186/s12893-025-02890-0.
Anterior Lumbar Interbody Fusion (ALIF) is a commonly performed spine surgery procedure used to treat lumbar conditions such as degenerative disc disease, spondylolisthesis, and spinal deformities. Traditionally, it has been performed using open and mini-open surgical techniques. Recently, however, laparoscopic and robotic-assisted ALIF have gained attention for their potential benefits, including shorter recovery times, fewer complications, and improved patient outcomes. However, the safety, effectiveness, and long-term outcomes of these newer techniques remain to be fully compared to conventional methods.
The systematic review was conducted in accordance with the PRISMA 2020 guidelines. MEDLINE and Cochrane databases were searched for studies on laparoscopic and robotic approaches to the anterior spine, with a focus on ALIF. Article selection and data extraction were independently conducted by two reviewers. Studies involving animal models, non-ALIF robotic techniques, or non-English publications were excluded.
A total of 650 articles were initially identified. After screening, a full-text review was conducted on 80 articles, of which 48 studies met the inclusion criteria: 42 focused on laparoscopic ALIF (L-ALIF) and 6 on robotic-assisted ALIF (R-ALIF). Laparoscopic ALIF achieved similar outcomes to mini-open methods, offering limited consistent benefits while presenting challenges such as a steep learning curve and a higher risk of retrograde ejaculation. Data on robotic-assisted ALIF, though limited, indicated improved precision and a reduced rate of intraoperative complications. However, high costs, logistical challenges, and the lack of substantial long-term outcome data remain significant barriers to the broader adoption of this technique in spine surgery.
L-ALIF and R-ALIF present promising minimally invasive alternatives to mini-open ALIF approaches. L-ALIF yields outcomes similar to mini-open techniques, though its technical demands warrant careful consideration. R-ALIF shows potential for improved precision and reduced complications, but logistical and financial constraints limit its wider adoption. Future studies should focus on multicenter prospective trials, alongside efforts to reduce costs and enhance training, to refine the role of these techniques in optimizing patient outcomes.
腰椎前路椎间融合术（ALIF）是一种常用于治疗腰椎疾病的脊柱外科手术，如椎间盘退变、椎体滑脱和脊柱畸形。传统上，该手术采用开放和微创开放手术技术进行。然而，近年来，腹腔镜和机器人辅助的ALIF因其潜在的优势而受到关注，包括恢复时间更短、并发症更少以及患者预后改善。然而，这些新技术的安全性、有效性和长期疗效仍有待与传统方法进行全面比较。
本系统评价按照PRISMA 2020指南进行。检索MEDLINE和Cochrane数据库中关于腹腔镜和机器人辅助脊柱前路手术的研究，重点是ALIF。文章筛选和数据提取由两名审稿人独立进行。排除涉及动物模型、非ALIF机器人技术或非英文出版物的研究。
最初共识别出650篇文章。筛选后，对80篇文章进行了全文审查，其中48项研究符合纳入标准：42项聚焦于腹腔镜ALIF（L-ALIF），6项聚焦于机器人辅助ALIF（R-ALIF）。腹腔镜ALIF取得了与微创开放方法相似的结果，虽有有限的一致益处，但也存在诸如学习曲线陡峭和逆行射精风险较高等挑战。关于机器人辅助ALIF的数据虽然有限，但表明其精度有所提高，术中并发症发生率降低。然而，高成本、后勤挑战以及缺乏大量长期疗效数据仍然是该技术在脊柱手术中更广泛应用的重大障碍。
L-ALIF和R-ALIF为微创开放ALIF方法提供了有前景的替代方案。L-ALIF产生的结果与微创开放技术相似，但其技术要求值得仔细考虑。R-ALIF显示出提高精度和减少并发症的潜力，但后勤和经济限制限制了其更广泛的应用。未来的研究应侧重于多中心前瞻性试验，同时努力降低成本并加强培训，以完善这些技术在优化患者预后方面的作用。
