Extended uses of robots in spine surgery beyond thoracolumbar pedicle screws: A narrative review.

Robotic assistance in spine surgery has matured considerably over the past two decades, with its initial role confined largely to thoracolumbar pedicle screw placement. As robotic platforms have evolved from bone-mounted miniature systems to contemporary real-time navigation platforms integrating intraoperative three-dimensional imaging, surgeons have progressively extended robotic guidance to technically demanding procedures across the entire spinal axis. This narrative review synthesizes the current evidence for extended robotic applications beyond standard thoracolumbar (T1–S1) pedicle screws. Five principal categories of extended application are examined: (1) cervical spine fixation, including subaxial pedicle screws (C3–C7), upper cervical constructs (C1–C2), and percutaneous cervical fracture fixation; (2) spinopelvic and pelvic procedures, particularly S2 alar-iliac screw placement; (3) vertebral augmentation, including vertebroplasty, kyphoplasty, and sacroplasty; (4) biopsy and targeted puncture workflows; and (5) anterior and lateral interbody fusion approaches. For each category, we review the available evidence on accuracy, safety, clinical outcomes, and technical considerations. Across these extended applications, reported accuracy rates generally range from 93% to 99.8%, with low complication rates and favorable perioperative outcomes. However, the evidence base is dominated by retrospective case series and single-center experiences, with very few randomized controlled trials. We identify critical gaps in the literature and propose directions for future research, including the need for multicenter prospective studies, standardized outcome reporting, cost-effectiveness analyses, and long-term follow-up.