Robotic versus non-robotic sacroiliac joint fusion: a meta-analysis

INTRODUCTION: This meta-analysis aimed to compare intraoperative metrics and postoperative outcomes of sacroiliac joint fusions (SIJF) performed under robotic versus non-robotic navigation. EVIDENCE ACQUISITION: , 2025. Before data analysis, patients were split into robotic and non-robotic fusion groups, and the non-robotic group was further split into fluoroscopic (F), virtual surgical planning (2D), and stereotactic (3D) navigation subgroups. Risk of bias was assessed using the revised Graphical Appraisal Tool for Epidemiological Studies (GATE). Datasets were analyzed using MedCalc and Stata. EVIDENCE SYNTHESIS: Twenty papers describing 1581 SIJFs were analyzed for visual analogue scale (VAS) pain, Oswestry Disability Index (ODI), and postoperative complications. ODI and VAS showed postoperative improvement across all groups, with a steeper VAS reduction in the robotic group. Postoperative complication rates were lowest in the non-robotic (2D) subgroup, and lower in the robotic group than in the non-robotic (3D) subgroup. The non-robotic (F) subgroup had the lowest rate of new pain, whereas the robotic group had the highest. The robotic group showed the lowest rate of hematomas. Qualitative analysis of reported data suggests that robotic navigation demonstrates the highest accuracy rate, whereas fluoroscopy demonstrates the lowest. The results, although consistent, were not statistically significant, likely due to substantial heterogeneity among studies. CONCLUSIONS: Findings indicate a reduction in postoperative pain and favorable outcomes across both navigation modalities. Additionally, robotic approaches provide an added benefit of reducing intraoperative radiation exposure. Further prospective comparative studies with larger sample sizes are needed to obtain statistically significant comparative data between the groups and to reach definitive conclusions.