Robotic spine surgery has expanded rapidly in clinical practice, raising the question of whether it represents a genuine clinical advance or whether it is primarily a marketing tool used to attract patients. This Privat-Docent thesis evaluates the major existing robotic platforms used for spinal instrumentation, focusing on accuracy, safety, workflow integration, and the strength of current clinical evidence.

The initial goals of robotic systems were to improve accuracy, reduce human error and cognitive stress on surgeons, and encourage the development of minimally invasive procedures. Pedicle screw placement accuracy exceeds 95% with modern platforms like ExcelsiusGPS® and Mazor X Stealth Edition®, which also significantly lower perioperative radiation exposure. However, whether compared to traditional freehand methods or navigation-assisted surgery, the available data does not show better patient-reported outcomes or long-term clinical results. Robotics has some limitations including potential tracking errors, workflow interruptions, the need for a strong reference frame, and high costs for buying and maintaining the technology. Furthermore, public opinion frequently overestimates the clinical benefits of new technologies, which is sometimes made worse by marketing campaigns that come after the products are on the market.

Future advances will most likely overcome current constraints by introducing novel navigation technologies like electromagnetic tracking or ultrasound-guided navigation, as well as increasing the integration of multimodal sensor systems. Improving robotic autonomy to do increasingly difficult procedures, such as decompressions and osteotomies, will be the next major step.

In summary, modern robotic spine surgery provides significant technical advantages but has yet to show a clear effect on patient outcomes. Its future value will depend on technological progress, thoughtful integration into surgical practice, and rigorous clinical evaluation of its true impact on patient care.