Current Concepts of Spine Robotic Assistance versus Freehand Techniques in Spine Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: Robotic assistance in spinal surgery has completely changed the face of the practice over recent decades. The concept of pedicle screw fixation, introduced in the early 1950s, has grown to be one of the cornerstones of treatment for various spinal pathologies. The purpose of this study is to evaluate surgical outcomes and different treatment modalities in spinal pathologies by comparing robotic-assisted techniques with conventional freehand techniques. Methods: A systematic review and meta-analysis were performed based on the PRISMA guidelines. A literature search was conducted using major databases such as ScienceDirect and PubMed/MEDLINE. Statistical analyses were performed using IBM SPSS software, R software, and Microsoft Excel. Peer-reviewed studies published in the English language up to January 2025 were included. Results: Results were compiled from a total of 2,592 patients who underwent robotic neuronavigation-guided spinal surgery, reflecting the precision and efficacy of state-of-the-art robotic technologies in spinal surgery. Of these, 2,219 patients were treated with robotic- assisted pedicle screw placement, while 2,294 patients were treated with conventional freehand or fluoroscopy-guided techniques. Conclusion: Our findings have shown that robotically assisted spine surgery is indeed more accurate, with reported rates of up to 90% precision in pedicle screw placement compared to freehand techniques. © 2025 Tehran University of Medical Sciences.