Objective <p>This study aims to evaluate the clinical efficacy of arthroscopy-assisted unilateral spinal surgery (AUSS)–transforaminal lumbar interbody fusion (TLIF) combined with TianJi ROBOT-assisted (RA) percutaneous pedicle screw fixation (PPSF), in comparison with conventional open transforaminal lumbar interbody fusion (TLIF), for the treatment of single-level lumbar spondylolisthesis. A comparative analysis of perioperative parameters and radiographic outcomes was conducted between the two surgical techniques.</p> Methods <p>This study included patients who underwent their first single-level TianJi ROBOT-assisted AUSS-TLIF or conventional TLIF at our institution between January 2023 and May 2024. Baseline characteristics, including age, sex, body mass index (BMI), diagnosis, and surgical segment, were collected. Perioperative laboratory indices, intraoperative blood loss, operative duration, total length of hospital stay, and postoperative complications were recorded for both groups. Clinical efficacy was evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) preoperatively, at 1 week and 3 months postoperatively, and at the final follow-up. Radiographic assessments were conducted preoperatively and at the final follow-up using X-rays to measure the height of adjacent intervertebral discs, the slippage distance of the vertebral body, and to calculate the slippage correction rate. In addition, the Cobb angle was used to assess changes in lumbar lordosis (LL), segmental lordosis (SA), and sacral slope (SS).</p> Results <p>A total of 133 patients were enrolled in the study, including 62 in the AUSS-TLIF group and 71 in the TLIF group. No statistically significant differences were observed between the two groups in baseline characteristics, including age, sex, BMI, diagnosis, and surgical segment (<i>p</i> &gt; 0.05). In terms of surgical outcomes, the estimated intraoperative blood loss was significantly lower in the AUSS-TLIF group compared to the TLIF group (<i>p</i> = 0.004). However, the operative time was longer (<i>p</i> = 0.002), while the time to first ambulation was shorter (<i>p</i> = 0.020). No significant difference was found in the incidence of postoperative complications between the two groups (<i>p</i> &gt; 0.05). With respect to clinical efficacy, the AUSS-TLIF group demonstrated more rapid relief of back and leg pain, with statistically significant differences between the groups in VAS score, ODI score, and satisfaction at final follow-up (<i>p</i> &lt; 0.05). Radiographic outcomes revealed no significant differences between the groups in the correction of segmental or overall lumbar lordosis (SA and LL). However, the slippage correction rate was significantly higher in the AUSS-TLIF group (<i>p</i> &lt; 0.001).</p> Conclusion <p>Compared with conventional open TLIF, the AUSS-TLIF technique offers several clinical advantages, including more effective postoperative pain relief, significantly lower intraoperative blood loss, and a reduced length of hospital stay. These findings suggest that AUSS-TLIF may serve as a viable and promising alternative for the treatment of lumbar spondylolisthesis.</p>