Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 4 2025 12 02 147 55 Daniel Encarnación-Santos Resident, Department of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russia Gennady Chmutin Professor, Department of Neurosurgery of People of Friendship University, Moscow, Russia. Egor Chmutin Professor associated ,Department of Neurosurgery of People of Friendship University, Moscow, Russia. Ismail Bozkurt Assistant Professor; Department of Neurosurgery, Medical Park Ankara Hospital, Ankara, Turkey Bipin Chaurasia Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal 2025 05 17 2025 11 22 Background: Robotic assistance in spinal surgery has completely changed the face of the practice over recent decades. The concept of pedicle screw fixation, introduced in the early 1950s, has grown to be one of the cornerstones of treatment for various spinal pathologies. The purpose of this study is to evaluate surgical outcomes and different treatment modalities in spinal pathologies by comparing robotic-assisted techniques with conventional freehand techniques. Methods: A systematic review and meta-analysis were performed based on the PRISMA guidelines. A literature search was conducted using major databases such as ScienceDirect and PubMed/MEDLINE. Statistical analyses were performed using IBM SPSS software, R software, and Microsoft Excel. Peer-reviewed studies published in the English language up to January 2025 were included. Results: Results were compiled from a total of 2,592 patients who underwent robotic neuronavigation-guided spinal surgery, reflecting the precision and efficacy of state-of-the-art robotic technologies in spinal surgery. Of these, 2,219 patients were treated with robotic assisted pedicle screw placement, while 2,294 patients were treated with conventional freehand or fluoroscopy-guided techniques. Conclusion: Our findings have shown that robotically assisted spine surgery is indeed more accurate, with reported rates of up to 90% precision in pedicle screw placement compared to freehand techniques. https://jost.tums.ac.ir/index.php/jost/article/view/678 https://jost.tums.ac.ir/index.php/jost/article/download/678/441