Clinical Indicators of Robotic Assisted versus Conventional Spine Surgery: A Systematic Review
DOI:
https://doi.org/10.26911/jepublichealth.2026.11.02.06Abstract
Background: Spine surgery has technological breakthrough of robotic assistance systems. The objective of this review is to explore clinical outcome indicators employed for comparison of out-comes of robotic assisted surgery to conventional spine surgery under the framework of evidence-based practice.
Subjects and Method: Based on guidelines issued by PRISMA, we systematically searched multi-ple sources, including PubMed, Scopus, and Science Direct databases. Studies comparing robotic assisted and conventional spine surgery were screened and analysed. Clinical indicators were collected and categorized according to surgical, functional, and safety concerns.
Results: The 24 review papers reviewed were all published during 2017 – 2025. The study design studies included three RCTs, nineteen RC studies, one prospective controlled study and one PSMC study pointing to the recent incorporation of robotic technologies in spinal surgery. This has revealed five categories of clinical indicators: accuracy benchmarks, operative parameters, safety and complications, functional outcomes, recovery and hospitalization. The most often reported indicator was the precision of the placement of the pedicle screw, followed by time of operation and intraoperative blood loss. Radiation exposure is a very important measure of occupational health and safety. The goal of this comprehensive clinical framework is to identify a method whereby an evidence-based clinical practice framework for efficient application of technological adoption becomes possible which is in favour of sustainable use can help to guide fiscally responsible adoption.
Conclusion: The current review establishes a composite framework of clinical indicators of clinical considerations towards robotic versus conventional spine surgery across robotic versus conventional spine surgery, a comprehensive evaluation paradigm. This framework provides a foundation upon which future studies can proceed.
Keywords:
robotic, conventional, spine surgery, clinical indicatorsHow to Cite
References
Alshaibi R, Mohamed AA, Williams C, Lucke-Wold B (2025). Exoscope visualization, navigation guidance, and robotic precision in spine surgery. J Minim Invasive Spine Surg Tech. 10(1): 22–33. https://doi.org/10.211-82/jmisst.2024.01508.
Cui GY, Han XG, Wei Y, Liu YJ, He D, Sun YQ, Liu B, et al. (2021). Robot-assisted minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar spondylolisthe¬sis. J Orthop Surg. 13(7): 1960–1968. https://doi.org/10.1111/os.13044
Fan M, Liu Y, He D, Han X, Zhao J, Duan F, Liu B, et al. (2020). Improved Accu-racy of Cervical Spinal Surgery with Robot-Assisted Screw Insertion: A Prospective, Randomized, Controlled Study. Spine (Phila Pa 1976). 45(5): 285–291. https://doi.org/10.1097/-BRS.0000000000003258
Fan Y, Du J, Zhang J, Liu S, Xue X, Huang Y, Zhang J, et al. (2017). Comparison of accuracy of pedicle screw insertion among 4 guided technologies in spine surgery. Med Sci Monit, 23: 5960–5968. https://doi.org/10.12659/MS-M.905713.
Farber SH, Pacult MA, Godzik J, Walker CT, Turner JD, Porter RW, Uribe JS. (2021). Robotics in Spine Surgery: A Technical Overview and Review of Key Concepts. Front Surg. 8: 578674. https://doi.org/10.3389/fsurg.2021.578674
Feng S, Tian W, Sun Y, Liu Y, Wei Y. (2019). Effect of robot-assisted surgery on lumbar pedicle screw internal fixation in patients with osteoporosis. World Neurosurg. 125: e1057–e1062. https://doi.org/10.1016/j.wneu.2019.01.243
Feng S, Tian W, Wei Y. (2020). Clinical effects of oblique lateral interbody fusion by conventional open versus percutaneous robot-assisted minimally invasive pedicle screw placement in elderly patients. Orthop Surg, 12(1): 86–93. https://doi.org/10.1111/os.12587
Franceschini C, Ahmadi M, Zhang X, Wu K, Lin M, Weston R, Rodio A, et al. (2025). Revolutionizing spine surgery with emerging AI–FEA integration. J Robotic Surg. 19(1). https://doi.org/-10.1007/s11701-025-02772-w
Guan J, Feng N, Yu X, Yang K. (2024). Comparison of robot-assisted versus fluoroscopy-guided transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases: a systematic review and meta-analysis of randomized controlled trails and cohort studies. Syst Rev. 13: 170. https:/doi.org/10.1186/s13643-024-02600-6
Huang Y, He B, Zhao Z, Cheng Z, Yan L, Chang Z. (2025). Robot-assisted vs fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases: a comparative study. Med Sci Monit. 31: e949817. https://doi.-org/10.12659/MSM.949817.
Hwang YH, Ha BJ, Kim HC, Lee BH, Park JY, Chin DK, Yi S (2024). A propen-sity score matched cohort study comparing 3 different spine pedicle screw fixation methods: Freehand, fluoroscopy-guided, and robot-assisted techniques. Neurospine. 21(1): 83-94. https://doi.org/10.1424-5/ns.2448240.120.
Lai J, Tan H, Deng P, Wang Y, Huang Y, Feng H, Lan Z, et al. (2025). TiRobot-assisted percutaneous vertebroplasty in the management of middle and upper thoracic osteoporotic vertebral compression fracture. BMC Surg. 25(1). https://doi.org/10.1186/s1289-3-025-03049-7.
Lee YS, Cho DC, Kim KT (2024). Navigation-Guided/Robot-Assisted Spinal Surgery: A Review Article. Neuro-spine. 21(1): 8–17. https://doi.org/-10.14245/ns.2448256.128.
Li C, Li H, Su J, Wang Z, Li D, Tian Y, Yuan S, et al. (2024). Comparison of the Accuracy of Pedicle Screw Placement Using a Fluoroscopy-Assisted Free-Hand Technique with Robotic-Assisted Navigation Using an O-Arm or 3D C-Arm in Scoliosis Surgery. Global Spine J. 14(4): 1337–1346. https://doi.org/10.1177/21925682221143076.
Li H, Zou J, Yu J. (2024). Effect of robot-assisted surgery on clinical outcomes in patients with osteoporotic vertebral compression fractures after percuta-neous vertebral augmentation: a meta-analysis and a validation cohort. Clin Orthop Surg. 16(6): 948–961. https://doi.org/10.4055/cios24086.
Li S, Du J, Huang Y, Hao D, Zhao Z, Chang Z, Zhu J, et al. (2023). Comparison of the efficacies of TINAVI robot-assisted surgery and conventional open surgery for Levine–Edward type IIA (postreduction) hangman fractures. Sci Rep. 13(1). https://doi.org-/10.1038/s41598-023-43136-4.
Li T, Liao W, Hu J, Zhang W, Yu Y, Wang F, Liu X. (2025). Clinical and radiogra-phic comparison of robot-assisted single-position versus traditional dual-position lateral lumbar inter¬body fusion. J Neurosurg Spine. 42(4): 443–452. https://doi.org/10.-3171/2024.¬10.SPINE24808.
Li Y, Wei X, Liang Y, Song G (2023). Robot-assisted versus fluoroscopy-guided pedicle screw fixation of thoracolumbar compression fractures. J Med (Baltimore). 102(48): E36430. https:-//doi.org/10.1097/MD.0000000000036430
Liang L, Zhao C, Luo L, Liu L, Li P, Gao Y, Zhou Q. (2025). A comparative study of robot-assisted navigation versus C-arm fluoroscopy in percutaneous pedicle screw fixation for the treatment of thoracolumbar fractures. Sci Rep. 15(1). https://doi.org/10.103-8/s41598-025-12549-8
Liu ZJ, Gu Y, Jia J. (2022). Comparative retrospective study of triangular osteosynthesis with and without robotic assistance for unilateral unstable sacral fractures combined with lumbosacral junction injuries. BMC Surg. 22(1). https://doi.org/10.1186-/s12893-022-01857-9
Maman D, Mahamid A, Finkel B, Gan-Or H, Fournier L, Berkovich Y, Behrbalk E. (2024). Comparative evaluation of postoperative outcomes and expendi-ture between robotic and conventional single-level lumbar fusion surgery: a comprehensive analysis of nationwide inpatient sample data. Eur Spine J, 33(7): 2637–2645. https://doi.org/-10.1007/s00586-024-08273-y
Morello A, Colonna S, Lo Bue E, Chiari G, Mai G, Pesaresi A, Garbossa D, et al. (2025). Accuracy and safety between robot-assisted and conventional free-hand fluoroscope-assisted placement of pedicle screws in thoracolumbar spine: meta-analysis. Medicina (Kaunas). https://doi.org/10.3390/-medicina61040690.
Park J, Ham DW, Kwon BT, Park SM, Kim HJ, Yeom JS. (2020). Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications. Asian Spine J. 14(5): 694–701. https://doi.org/10.31616/asj.2020.0384
Seif H, Maragno E, Gallus M, Szeöke S, Schwake M. (2025). A retrospective cohort study comparing robot-assisted and conventional fluoroscopy-guided pedicle screw placement. J Clin Med, 14(19). https://doi-.org/10.3390/jcm14196831
Su XJ, Lv ZD, Chen Z, Wang K, Zhu C, Chen H, Han YC, et al. (2022). Com¬parison of accuracy and clinical outcomes of robot-assisted versus fluoroscopy-guided pedicle screw placement in posterior cervical surgery. Global Spine J, 12(4), 620–626. https://doi.org/10.1177/2192568220960406
Tan A, Ashrafian H, Scott AJ, Mason SE, Harling L, Athanasiou T, Darzi A. (2016). Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years. Surg Endosc. 30(10): 4330–4352. https://doi.org/10.1007/s00464-016-4752-x
Tao H, Huang Z, Shao S, Yang R, Yang K, Zhang Y, Li W, et al. (2024). Compa-rison of Robot-Assisted and Fluoro-scopy-Assisted Percutaneous Kypho-plasty for Bone Cement Distribution and Clinical Efficacy. Pain Physician. 27(8):E953-E963. https://pubmed.ncbi.nlm.nih.gov/39621996/.
Tong M, Zhang S, Zhang W, Mou L, Dong Z, Wang R, Li S, et al. (2024). Efficacy and safety of navigation robot-assisted versus conventional oblique lateral lumbar interbody fusion with internal fixation in the treatment of lumbar degenerative diseases: A retrospective study. J Medicine (US), 103(32): e39261. https://doi.org/10.-1097/MD.0000000000039261
Wang B, Cao J, Chang J, Yin G, Cai W, Li Q, Huang Z, et al. (2021). Effectiveness of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture. J Orthop Surg Res, 16(1). https://doi.org/10.1186/s13018021022110
Wang J, Miao J, Zhan Y, Duan Y, Wang Y, Hao D, Wang B. (2023). Spine Surgical Robotics: Current Status and Recent Clinical Applications. J Neurospine. 20(4): 1256–1271. https://doi.org/10.14245/ns.2346610.305
Wang K, Li H, Yan L, Zhang H, Zhang, Hao D (2025). Clinical efficacy comparison of Mazor X robot-assisted and traditional freehand techniques in the treatment of atlantoaxial fracture and dislocation. Eur J Med Res, 30(1). https://doi.org/10.1186/s40001025029599.
Wang Z, Tan Y, Fu K, Meng Z, Wang L (2022). Minimally invasive trans-superior articular process percutaneous endoscopic lumbar discectomy with robot assistance. BMC Muscu-loskelet Disord, 23(1). https://doi.org/10.1186/s12891022060608
Zeng G, Li Z, Hou J, Yu L, Cui Y, Zhu Y, Yao L, et al. (2025). Robot-Assisted Screw Fixation Combined With Endoscopic Bone Graft in the Minimally Invasive Treatment of Lumbar Spondylolysis: A Single-Center Retrospective Study. J Orthop Surg, 17(4): 1143–1151. https://doi.org/10.1111/os.1436
Zhan J, Xu W, Lin J, Luan J, Hou Y, Wang Y, Li Y, et al. (2022). Accuracy and safety of robot-assisted versus fluoro-scopy-guided posterior C1 lateral mass and C2 pedicle screw internal fixation for atlantoaxial dislocation: A preliminary study. BioMed Res Int, 2022. https://doi.org/10.1155/2022/-8508113
Zhang Q, Han XG, Xu YF, Fan MX, Zhao JW, Liu YJ, He D, et al. (2020). Robotic navigation during spine surgery. Expert Rev Med Devices. 17(1): 27–32). https://doi.org/10.1080/17434440.2020.1699405.
Zhou L, Feng Z, Li Z, Wang Y, Hai Y. (2025). Safety and efficacy of robot-assisted technology in severe complex and non-severe spinal deformity correction: a retrospective comparative study. J Orthop Surg Res, 20(1). https://doi.org/10.1186/s13018025061584.
1.jpg)
