J Neurosurg Spine 44:349–354, 2026
This case series from a tertiary academic spine center reports outcomes of robot-assisted percutaneous pars repair in nine adolescents with symptomatic lumbar spondylolysis who failed conservative management. The authors describe a single–midline incision technique using CT-based robotic guidance and a single lagged transdefect screw, detailing operative workflow, implant sizes, and a standardized postoperative rehabilitation protocol.
Results show most patients returned to preinjury or higher activity within months, with low complication rates and radiographic evidence of union in those who obtained CT follow-up. The authors conclude that minimally invasive robotic pars repair is a viable option after failed nonoperative care and advocate timely surgical consultation to potentially accelerate return to sport and avoid progressive spondylolisthesis.
Clinical problem Symptomatic lumbar pars interarticularis fractures (spondylolysis) are a common cause of adolescent low-back pain; nonoperative care with activity modification is standard first-line treatment.
Nonunion risk Despite conservative management, about 20% of patients may progress to symptomatic nonunion, and some can later develop spondylolisthesis that may require fusion.
Study aim Robotic surgical guidance was used to enable percutaneous pars screw placement; the series reports the largest cohort of adolescents treated with robot-assisted pars repair to date.
Design & cohort Retrospective review of a prospectively collected database identified 9 adolescents/young adults (13–25 years) treated with a single-screw pars repair technique.
Technique Using Excelsius robotic planning/registration and intraoperative 3D imaging, bilateral screw trajectories were planned to converge so bilateral pars screws could be placed through a single 1–2 cm midline incision; compression was achieved via a “lag-by-technique” preparation without direct pars visualization/grafting.
Postop protocol Patients walked only for 2 weeks, then added stationary biking for 2 weeks, followed by 4 weeks of sport-directed physical therapy; if tolerated symptom-free, they were cleared for activity (cleared to begin return-to-sport training at 4 weeks).
Outcomes Mean preop activity cessation at consultation was 8.6 ± 10.6 months; at mean follow-up 11.4 ± 9.1 months, 78% had returned to baseline activity or were cleared to return to sport.
Safety/efficacy conclusion Robot-assisted pars repair was reported as a safe, effective option after failed nonoperative care, enabling return to activity in as little as 8 weeks; a single lag-style screw may be clinically effective compared with prior open debridement/bone-grafting approaches.
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