Advancing spine surgery: Evaluating the potential for full robotic automation.

Introduction: The use of robotic systems in spine surgery is expanding, with growing interest in the potential for full automation. This review explores current robotic technologies, their limitations, and future automation possibilities, focusing on technical and practical aspects. Research question: What are the current capabilities and limitations of robotic systems in spine surgery, and how might advancements in tracking technologies facilitate a transition toward greater automation? Material and methods: A narrative review of literature on robotic spine surgery systems was conducted, analyzing benefits, accuracy, limitations, and innovations necessary for full automation. Focus was placed on trajectory-guiding technologies, such as optical tracking and alternative tracking methods. Results: Current robotic systems (e.g., Cirq®, Mazor X™, ExcelsiusGPS™) assist in trajectory guidance but lack autonomy. Optical tracking systems present challenges, such as obstruction vulnerability and inaccuracies in complex constructs. Conversely, encoder-based tracking demonstrated superior accuracy, offering a promising pathway toward increased automation. The potential advantages of robotics over conventional navigation, including their nature and clinical relevance, remain a topic of active discussion. However, the inherent complexity of spine surgery and the critical role of human decision-making remain substantial barriers. Discussion and conclusion: While full automation in robotic spine surgery is not yet attainable, advancements in tracking technologies point to a future of enhanced robot-surgeon collaboration, which could optimize clinical outcomes and improve procedural safety.