Thoracolumbar burst fractures: robot-assisted mono-segment fixation with vertebral body grafting versus short-segment fixation — a propensity score-matched cohort study

PURPOSE: To compare robot-assisted mono-segment pedicle fixation with vertebral body grafting (RMF-VBG) versus conventional short-segment fixation with grafting (SF-VBG) for neurologically intact thoracolumbar burst fractures, focusing on radiographic maintenance of correction and perioperative efficiency. METHODS: We performed a single-center retrospective cohort study (2018-2022) including adults with single-level AO-A3 fractures (T11-L2), ASIA E, treated within 14 days. One-to-one propensity score matching balanced baseline factors. The primary endpoint was loss of sagittal Cobb angle (SCA) at 12 months. Secondary outcomes included operative time, blood loss, postoperative length of stay (postop LOS), pain (VAS), Oswestry Disability Index (ODI), anterior vertebral body height ratio (AVBHr), pedicle screw accuracy (Gertzbein-Robbins), facet joint violation (FJV), perioperative morbidity and adjacent segment degeneration (ASD). RESULTS: A total of 152 patients were matched (76 per group). RMF-VBG achieved significantly shorter operative time (62.38 ± 14.26 vs 89.56 ± 20.36 min), reduced blood loss (82.54 ± 19.69 vs 126.38 ± 28.26 mL), and shorter postop LOS (5.23 ± 1.72 vs 7.16 ± 1.39 days; all p