Galieri Gianluca, Orlando Vittorio, Altieri Roberto, Barbarisi Manlio, Olivi Alessandro, Sabatino Giovanni, La Rocca Giuseppe
Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy.
Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy.
J Clin Med. 2025 May 13;14(10):3390. doi: 10.3390/jcm14103390.
: Lumbar spine surgery has undergone significant technological transformation in recent years, driven by the goals of minimizing invasiveness, improving precision, and enhancing clinical outcomes. Emerging tools-including robotics, augmented reality, computer-assisted navigation, and artificial intelligence-have complemented the evolution of minimally invasive surgical (MIS) approaches, such as endoscopic and lateral interbody fusions. : This systematic review evaluates the literature from February 2020 to February 2025 on technological and procedural innovations in LSS. Eligible studies focused on degenerative lumbar pathologies, advanced surgical technologies, and reported clinical or perioperative outcomes. Randomized controlled trials, comparative studies, meta-analyses, and large case series were included. : A total of 32 studies met the inclusion criteria. Robotic-assisted surgery demonstrated high accuracy in pedicle screw placement (~92-94%) and reduced intraoperative blood loss and radiation exposure, although long-term clinical outcomes were comparable to conventional techniques. Intraoperative navigation improved instrumentation precision, while AR enhanced ergonomic workflow and reduced surgeon distraction. AI tools showed promise in surgical planning, guidance, and outcome prediction but lacked definitive evidence of clinical superiority. MIS techniques-including endoscopic discectomy and MIS-TLIF-offered reduced blood loss, shorter hospital stays, and faster recovery, with equivalent pain relief, fusion rates, and complication profiles compared to open procedures. Lateral and oblique approaches (XLIF/OLIF) further optimized alignment and indirect decompression, with favorable perioperative metrics. : Recent innovations in lumbar spine surgery have enhanced technical precision and perioperative efficiency without compromising patient outcomes. While short-term benefits are clear, long-term clinical advantages and cost-effectiveness require further investigation. Integration of robotics, navigation, AI, and MIS into spine surgery reflects an ongoing shift toward personalized, data-driven, and less invasive care.
近年来，在将侵入性降至最低、提高精准度以及改善临床结果目标的推动下，腰椎手术经历了重大的技术变革。包括机器人技术、增强现实、计算机辅助导航和人工智能在内的新兴工具，辅助了诸如内镜和外侧椎间融合等微创手术（MIS）方法的发展。
本系统评价评估了2020年2月至2025年2月间关于腰椎手术技术和手术创新的文献。符合条件的研究聚焦于退行性腰椎疾病、先进的手术技术，并报告了临床或围手术期结果。纳入了随机对照试验、比较研究、荟萃分析和大型病例系列。
共有32项研究符合纳入标准。机器人辅助手术在椎弓根螺钉置入方面显示出较高的准确性（约92%-94%），并减少了术中失血和辐射暴露，尽管长期临床结果与传统技术相当。术中导航提高了器械置入的精准度，而增强现实改善了人体工程学工作流程并减少了术者的注意力分散。人工智能工具在手术规划、引导和结果预测方面显示出前景，但缺乏临床优越性的确切证据。微创手术技术，包括内镜下椎间盘切除术和微创经椎间孔腰椎椎体间融合术，减少了失血、缩短了住院时间并加快了恢复，与开放手术相比，在缓解疼痛、融合率和并发症方面相当。外侧和斜外侧入路（XLIF/OLIF）进一步优化了对线和间接减压，围手术期指标良好。
腰椎手术的近期创新提高了技术精准度和围手术期效率，而不影响患者预后。虽然短期益处明显，但长期临床优势和成本效益仍需进一步研究。将机器人技术、导航、人工智能和微创手术整合到脊柱手术中，反映了正朝着个性化、数据驱动和侵入性更小的医疗方向发展。
