Robot-assisted pedicle screw placement in spinal surgery: an updated systematic umbrella review and meta-meta-analysis of comparisons against freehand and navigation-guided techniques

Robot-assisted pedicle screw placement demonstrates superior accuracy versus freehand and navigation-guided methods, supported by convincing (class I) evidence. Highly suggestive (class II) evidence also supports its superiority in perfect placement and shortening hospital stays, while suggestive (class III) evidence indicates reduced blood loss and radiation. These findings, supported by a robust evidence base, underscore the need for standardized clinical guidelines to maximize impact on patient outcomes.