Navigation and Robotics in Minimally Invasive Spine Surgery: From Image Guidance to Integrated Digital Workflows

Objective: This review examines the foundations, evolution, and clinical use of computer navigation and robotics in minimally invasive spine surgery (MISS), with a focus on lumbar and thoracolumbar decompression, fusion, deformity correction, and percutaneous fixation.Methods: This review describes the development, technical principles, and clinical applications of computer-assisted navigation and robotic-assisted technologies in MISS. Relevant studies were identified by searching PubMed/MEDLINE and Google Scholar for English-language articles on spinal navigation, robotic-assisted spine surgery, MISS, pedicle screw placement, spinal deformity correction, radiation exposure, surgical workflow, learning curves, and health-economic outcomes. Priority was given to peer-reviewed articles, including systematic reviews, meta-analyses, prospective studies, retrospective cohort studies, and key historical reports on the development and current use of navigation and robotics in MISS. Included studies were published between 1986 and 2026.Results: Navigation and robotic technologies have expanded the technical capabilities of MISS by improving anatomical visualization and enabling accurate guidance of instrumentation through limited surgical corridors. Unlike conventional fluoroscopy-based techniques, navigation systems generate 3-dimensional anatomical maps that allow real-time instrument tracking relative to patient-specific anatomy. These advances have been associated with improved instrumentation accuracy and reduced radiation exposure for surgical personnel, particularly during complex thoracolumbar instrumentation procedures. However, although robotic systems appear to improve technical performance, many studies have reported limited differences in postoperative pain, recovery, and reoperation rates. These findings suggest that factors beyond procedural accuracy may influence long-term patient outcomes.Conclusion: Computer navigation and robotics are important components of modern MISS. These technologies can improve accuracy, consistency, and workflow control in complex procedures. Their principal value lies in supporting surgical decision-making through precise imaging, planning, and execution. Future progress will depend on integrated systems and high-quality studies that clarify their long-term clinical and economic benefits.