Robotic-assisted spine surgery in Sub-Saharan Africa: a meta-analysis of cost–benefit and implementation challenges

Abstract Background Robotic-assisted spine surgery (RASS) represents a transformative advancement in spinal neurosurgery, offering superior precision, reduced complications, and improved clinical outcomes compared to conventional freehand or fluoroscopy-guided techniques. However, its implementation in Sub-Saharan Africa (SSA) faces significant challenges, including prohibitive costs, infrastructure limitations, and inconsistent maintenance capabilities. This meta-analysis aimed to evaluate the cost–benefit ratio of RASS versus conventional techniques in SSA, analyze clinical outcome differences relevant to regional needs, and propose feasible implementation models tailored to resource-constrained settings. Methods A systematic review and meta-analysis were conducted following PRISMA guidelines, incorporating nine key studies identified through a comprehensive search of PubMed, Embase, Cochrane Library, Scopus, and African Journals Online. The analysis focused on randomized controlled trials, prospective cohort studies, and high-quality retrospective comparisons. Outcomes included screw accuracy, complication rates, cost data, operative times, and hospital stays. Statistical analysis was performed using RevMan 5.4 and R software, with pooled odds ratios and weighted mean differences calculated for clinical and economic outcomes. Results RASS demonstrated significant advantages, including higher screw accuracy (94–98% vs. 85–91%), reduced neurological complications (1.9% vs. 4.3%), and lower revision rates (3.1% vs. 5.2%). However, upfront costs were 5–15 times higher ($500,000–$1.5 M per system), with per-case disposables costing 4–8 times more ($800–$1,200 vs. $100–$300). Operational challenges included longer setup times and infrastructure dependencies. Despite clinical benefits, the economic burden and logistical barriers render widespread RASS adoption impractical in most SSA settings without external funding or innovative financing models. Conclusion While RASS offers compelling clinical improvements for spinal surgery in SSA, its high costs and infrastructure demands currently limit feasibility. Wider adoption will depend on practical measures such as strategic partnerships, phased implementation, and strengthening of local technical and surgical capacity.