Robotics in Modern Spine Surgery and Its Technological Evolution with Impact on Surgical Accuracy and Clinical Outcomes

Abstract

Robotic-assisted spine surgery has emerged as a transformative advancement in modern orthopaedic and neurosurgical practice. Over the past two decades, the integration of robotic platforms into spinal procedures has fundamentally altered paradigms of surgical precision, intraoperative navigation, and postoperative recovery. Early computer-assisted systems have gradually evolved into contemporary autonomous guidance platforms, including the Mazor X Stealth Edition, ROSA Spine, and Excelsius GPS. This evolution reflects a broader technological revolution driven by the convergence of robotics, artificial intelligence, and advanced imaging modalities. The present review aims to provide a comprehensive synthesis of the historical trajectory, technological components, clinical applications, and emerging challenges associated with robot-assisted spine surgery. Specific emphasis is placed on surgical accuracy, workflow integration, and patient outcomes. A systematic search of PubMed, Scopus, and Web of Science databases was conducted for literature published between 1990 and 2025. Search keywords included "robotic spine surgery," "pedicle screw accuracy," "computer-assisted spinal navigation," and "robotic-assisted vertebral surgery." Priority was given to randomized controlled trials, meta-analyses, systematic reviews, and high-impact retrospective cohort analyses. Robotic systems consistently demonstrate superior pedicle screw placement accuracy compared to freehand or fluoroscopy-guided techniques. Grade A accuracy ranges from 85% to 98% for robotic-assisted procedures versus 68% to 85% for conventional methods. Multiple meta-analyses have further confirmed significant reductions in complication rates, revision surgery rates, radiation exposure, and hospital length of stay within robotic cohorts. Although high upfront costs and steep learning curves persist as limitations, emerging evidence supports favorable cost-effectiveness over long-term follow-up. In conclusion, robotic-assisted spine surgery has transitioned from an experimental technology to a clinically validated modality with well-documented benefits in accuracy and safety. Continued innovation in haptic feedback, artificial intelligence integration, and device miniaturization will further entrench robotics as a cornerstone of modern spinal care.