Robotic guidance in posterior transdiscal fixation for high-grade spondylolisthesis: a case series

Background: Spondylolisthesis affects a considerable portion of the population, yet high-grade spondylolisthesis (HGS) is relatively uncommon and is associated with substantial anatomical distortion, instability, and neurologic risk that complicate surgical management. Posterior transdiscal (PTD) fixation has emerged as a minimally invasive, biomechanically robust strategy that enables circumferential stabilization across the lumbosacral junction while minimizing soft-tissue disruption. The integration of robotic guidance in spine surgery may further enhance pedicle and transdiscal screw placement accuracy, streamline workflow, and improve patient safety by reducing reliance on fluoroscopy and minimizing trajectory deviations. Case Description: We conducted a retrospective case series of five consecutive patients with symptomatic HGS who underwent robotic-assisted PTD fixation at a single tertiary center. Demographic characteristics, operative variables, and perioperative events were recorded. Standardized radiographic metrics (including slip percentage and segmental alignment) and clinical outcomes were collected preoperatively and at routine postoperative intervals. Patient-reported outcomes included visual analog scale (VAS) pain scores and Oswestry Disability Index (ODI). All cases achieved successful screw placement as planned by the robotic workflow without intraoperative revisions. Statistically significant improvements were observed in VAS pain and ODI from baseline to final follow-up. Radiographs demonstrated maintenance of construct integrity and improved alignment parameters. No perioperative complications, neurologic deficits, returns to the operating room (OR), or implant-related adverse events were observed during the study period. Conclusions: Robotic guidance in PTD fixation for HGS appears to enhance procedural accuracy and safety, facilitating reliable instrumentation in challenging anatomy while potentially reducing operative risk, radiation exposure, and complications. In this preliminary series, patients experienced meaningful reductions in pain and disability with stable radiographic outcomes and an absence of perioperative adverse events. Larger comparative studies with longer follow-up are warranted to confirm durability, quantify radiation and efficiency benefits, and define patient selection criteria for maximal benefit.