Mechanized precision: the rise of robotic systems in spinal surgery

BACKGROUND: Robot-assisted spinal surgery has rapidly evolved into a transformative innovation. Initially developed for pedicle screw placement, current systems now support broader indications, offering enhanced precision, reduced radiation exposure and potentially improved perioperative outcomes; however, widespread adoption remains limited by technical, financial and educational barriers. OBJECTIVE: This narrative review provides a comprehensive overview of the current state of robotic spinal surgery, addressing technological evolution, platform-specific characteristics, clinical outcomes and future perspectives. METHODS: A structured literature review was conducted, synthesizing clinical studies, meta-analyses and technical reports. Key outcome measures included screw placement accuracy, radiation exposure, blood loss, operative time and complication rates. RESULTS: Robotic systems achieve > 95% grades A/B pedicle screw accuracy. Studies report significantly reduced radiation and blood loss, especially in minimally invasive procedures. Operative times improve with experience. Major challenges include high costs, steep learning curves and limited intraoperative autonomy. Emerging applications and integration of artificial intelligence (AI) are expanding the clinical utility. CONCLUSION: Robotics offer significant potential for improving precision, safety, and standardization in spinal surgery. Continued advancements in AI, training and cost-efficiency are crucial for broader clinical integration.