Spinal surgery has consistently leveraged technological advancements throughout history, significantly enhancing patient outcomes, from the adoption of the operative microscope to fluoroscopy, or the advent of pioneering minimally invasive techniques. The dawn of the fourth industrial revolution, with the emergence of cyber-physical systems, has heralded a new era of technological breakthroughs, including robotics, virtual reality, and more. Hence, we wondered: How does spinal surgery fit into this rapidly changing technological landscape? This chapter presents a narrative review of the latest trends and developments in spinal surgery technologies, critically examining their cost-effectiveness, utility, precision gains, or learning curves. The discussion encompasses technologies related to the surgeon’s environment (surgical tables, instruments, hemostatic agents), surgical techniques (minimally invasive approaches, endoscopy), and the concept of the “augmented surgeon” (robotics, navigation systems, augmented reality). In assessing these advancements, the chapter seeks to provide a comprehensive overview of how emerging technologies are reshaping spinal surgery. It addresses the potential benefits and limitations of each innovation, considering their impact on surgical precision, patient safety, and overall surgical outcomes, with offering insights into the practical applications and future potential of these technologies. The aim is to define whether these technological advances represent genuine progress or are merely transient trends.