Robotic-assisted versus navigation-guided spinal surgery: a meta-analysis of perioperative, clinical outcomes, and complications

Robot-assisted and navigation-guided spinal instrumentation technologies have transformed spine surgery by improving precision and intraoperative safety. Despite widespread adoption, their relative performance across perioperative efficiency, radiographic accuracy, and complication profiles remains insufficiently clarified.

A systematic search of PubMed, Scopus, Cochrane Library, and Google Scholar was conducted through December 2025. Sixteen comparative studies involving 59,474 patients (robot-assisted = 11,059; navigation-guided = 48,787) were included. Extracted outcomes included operative time, blood loss, length of stay, radiation exposure, fluoroscopy duration, screw deviation, endplate breach, facet violation, Cobb angle correction, and intra- and postoperative screw revision and complication rates. Pooled effect estimates were calculated for continuous and dichotomous variables. Subgroup analyses were performed according to underlying spinal pathology (degenerative lumbar fusion, thoracolumbar posterior instrumentation, and spinal deformity).

Robot-assisted surgery demonstrated significantly shorter fluoroscopy time (MD − 3.44 s; p = 0.03), lower pedicle screw deviation (MD − 0.16 mm; p = 0.003), and fewer intraoperative screw revisions (RR 0.42; p = 0.009). Navigation-guided surgery showed lower endplate breach rates (RR 2.32; p = 0.007). No significant differences were observed in operative time, blood loss, length of stay, total radiation exposure, facet violation, Cobb angle correction, or overall complication rates (all p > 0.05). Subgroup analyses showed overall consistency across pathology types: in degenerative lumbar fusion cohorts, robotic assistance was associated with reduced radiation exposure (MD − 5.27 mSv; p < 0.001) and fewer intraoperative screw revisions (RR 0.41; p = 0.02), whereas in deformity cohorts, navigation-guided techniques demonstrated shorter operative time (MD 11 min; p = 0.01) and lower radiation exposure (MD 11.42 mSv; p < 0.001). Most other outcomes remained comparable across subgroups.

Current evidence suggests broadly comparable short-term outcomes between robotic-assisted and navigation-guided spinal surgery. However, while each modality demonstrated selective technical advantages, the overall strength of evidence remains insufficient to support definitive comparative conclusions. High-quality randomized trials are warranted.