Table 1

Study characteristics providing information on the study design, comparative intervention, instrument details, study duration, population, number of patients, gender percentages, and body mass index of included patients.

Study	Study Design	Group Comparison	Study Group	Details of the Image Guidance System	Control Group	Details of the Image Guidance System	Duration	Population	Total	No. of Patients		Age, y		Gender (% men)		BMI, kg/m²
Study	Study Design	Group Comparison	Study Group	Details of the Image Guidance System	Control Group	Details of the Image Guidance System	Duration	Population	Total	T	C	T	C	T	C	T	C
Allam et al, 201325	Cohort study	NC	Navigated	3D navigation	Conventional		January 2009–March 2010	Internal fixation for fractures, tumors, and spondylodiscitis of the thoracic spine and degenerative lumbar lordosis	45	27	18
Alqurashi et al, 202126	Prospective cohort study	NC	Navigated	CT-guided navigation	Conventional		March 2016–April 2017	Instrumented lumbar fusion using transpedicular screws	57	15	42	59.3^{^a} (27–76)	45^{^a} (20–61)	26.7	42.9	29.5^{^a} 23,24,27–36	30.1^{^a} 22–24,27–38
Baky et al, 201939	Retrospective cohort study	NC	Navigated	CT-guided navigation	Conventional		2009–2015	Younger than 19 y underwent pedicle screw instrumentation	217	105	112	13.9	13.8	32.38	25
Bovonratwet et al, 201840	Retrospective cohort study	NC	Navigated	Any navigation	Conventional		2010–2015	Posterior lumbar fusion, excludes multiple-level cases, uninstrumented cases, cases involving trauma, fracture, neoplasms, infection, or patient age <18 y	5805	1161	4644	58.8	59	40.57	40.91	30.8	30.7
Budu et al, 202041	Retrospective cohort study	NC	Navigated	3D Iso-C scan	Conventional		2013–2018	Cases involving a pedicle or lateral mass screw insertion	176	total = 176
Crawford et al, 202242	Retrospective cohort study	NC	Navigated	O-arm	Conventional		June 2012–May 2016		155	84	71	53.37 (15.5)	52.89 (18.5)	54.7	42.2
De Biase et al, 202143	Retrospective cohort study	RC	Robotic	Mazor X Robot	Conventional		July 2017–March 2020	MIS TLIF	101	52	49	56 (11.7)	58.7 (10.5)	42.8	53	28.8 (4.8)	30.3 (4.6)
Du et al, 202044	Retrospective cohort study	RN	Robotic	Tinavi Robot	Navigated	O-arm	2017–2019	Thoracolumbar internal fixation with pedicle screws	302	136	166	58.6 (9.9)	60.1 (10.3)	54.4	51.8	22.5 (4.3)	23.2 (3.9)
Edström et al, 202045	Prospective study with retrospective control	AC	AR	ARSN	Conventional			Deformity surgery for scoliosis and kyphosis	44	15	29	28.3 (19)	27.8 (17.1)	46.6	31.37
Elmi-Terander et al, 202046	Prospective study with retrospective control	AC	AR	ARSN	Conventional				40	20	20	30 (19.4)	36.6 (23.2)	45	45	19.8 (2.1)	23.2 (5.5)
Fan et al, 201747	Retrospective cohort study	RNC	Robotic	SpineAssist	Navigated and conventional	O-arm	2017	Degenerative pathology	67	39	28	60.6 (7.9)	65.1 (8)	49	39	22.9 (4.7)	24.8 (3.5)
Fayed et al, 202048	Prospective comparative study	RC	Robotic	ExcelsiusGPS system	Conventional		December 2019–February 2020	Degenerative spine conditions	48	20	28	62.8^{^a} (44–75)	57.1^{^a} (53–83)	30.4	35.7	31.2 (5.8)	NA
Fraser et al, 201049	Cohort study	NC	Navigated	3D Iso-C C-arm	Conventional		December 2005–July 2007	Degenerative lumbar instability	42	29	13	55.1 (13.6)	48.4 (12)	41.4	46.2
Fu et al, 200850	Retrospective cohort study	NC	Navigated	CT	Conventional			Pedicle screw insertion below the level of T8	24	11	13
Gao et al, 202151	Retrospective cohort study	RC	Robotic	Mazor Renaissance Surgical guidance robot	Conventional		December 2017–February 2020	2-Level percutaneous endoscopic LIF or MIS-TLIF	41	18	23	61.6 (7.1)	62.4 (6.1)	44.4	47.8	26 (3.6)	25.5 (2.9)
García-Fantini et al, 201852	Retrospective cohort study	NC	Navigated	3D isocentric fluoroscopic navigation	Conventional		2012–2017	Open L4-L5-S1 fixation with pedicle screw implantation	135	96	39	60.6	58.7	28.12	23.07
Good et al, 202153	Prospective comparative study	RC	Robotic	Mazor Renaissance Surgical guidance robot	Conventional		October 2014–September 2018	Primary short lumbar or lumbosacral percutaneous/MIS spinal fusion	485	374	111	59 (12.6)	62.5 (12.8)	43.9	37.8	31.2 (6.8)	28.1 (5.2)
Gu et al, 202054	Prospective comparative study	AC	AR	HoloLens 2 mixed reality technology	Conventional		January 2017–October 2018	Lumbar disc herniation and/or lumbar spondylolisthesis	50	25	25	44.32 (3.78)	45.56 (3.93)	44	52
Han et al, 201055	RCT	NC	Navigated	3D computer navigation	Conventional		2006	Thoracic spine pedicle screw insertion	42	22	20
Han et al, 201956	RCT	RC	Robotic	TiRobot	Conventional		January 2016–September 2017	Thoracolumbar posterior fusion due to degenerative or traumatic disorders	234	115	119	54.6 (11.3)	56.1 (13.4)	52.17	51.26	25.7 (4.1)	24.9 (2.9)
Hyun et al, 201757	RCT	RC	Robotic	Mazor Renaissance Surgical guidance robot	Conventional		December 2013–January 2015	Primary lumbar interbody fusion	60	30	30	66.5 (8.1)	66.8 (8.9)	30	26.7	24.7 (2.6)	25.8 (3.3)
Ishikawa et al, 201058	Retrospective cohort study	NC	Navigated	3D fluoroscopy-based computer assisted	Conventional		2003–2008	Posterior cervical fixation	62	32	30	59.3 (9.8)	59.9 (18.3)	62.5	53.33
Jin et al, 201659	Retrospective cohort study	NC	Navigated	O-arm	Conventional		June 2011–September 2013	Dystrophic neurofibromatosis I associated scoliosis	31	12	19	14.8^{^a} 11–22	15.3^{^a} 12–24,27–29	38.46	47.37
Karamian et al, 202332	Retrospective cohort study	RC	Robotic	Globus Excelsius GPS and Medtronic Mazor Robotic Renaissance	Conventional		January 2014–August 2020	1–3-level lumbar fusion	262	85	177	65 (11.9)	64.9 (11.5)	44.7	44.6	29.7 (6.67)	29.5 (5.58)
Katsevman et al, 202160	Retrospective cohort study	RC	Robotic	Mazor X robot	Conventional		2017–2019	Posterior percutaneous thoracic and/or lumbar fixation surgery	37	17	20	61.4 (13.8)	57.3 (17.3)	75	52.94	32.3 (6.7)	31.9 (8.1)
Khanna et al, 201661	Retrospective cohort study	NC	Navigated	O-arm	Conventional		March 2005–May 2015	1-Level lumbar fusion surgery	136	73	63
Kim et al, 201762	RCT	RC	Robotic	Mazor Renaissance Surgical guidance robot	Conventional		December 2013–October 2014	Lumbar spinal stenosis	78	37	41	65.4 (10.4)	66 (8.6)	50	54.8	25.9	25.3
Kim et al, 201863	RCT	RC	Robotic	Mazor Renaissance Surgical guidance robot	Conventional		December 2013–October 2014	Degenerative spinal disease with lumbar spinal stenosis	78	37	41	65.4 (10.4)	66 (8.6)	51.4	54.8	25.9	25.3
Laine et al, 200064	RCT	NC	Navigated	Medivision	Conventional		April 1980–June 1999	Thoracolumbar and lumbosacral fusion	91	41	50
Lai et al, 202265	Retrospective cohort study	RC	Robotic	Mazor Renaissance Surgical guidance robot	Conventional		May 2018–September 2020	Degenerative lumbar disease underwent TLIF	108	29	79	66^{^a} (60–76.5)	64^{^a} (54.5–71)	48.3	41.8	27.4^{^a} (23.3–30.6)	25.9^{^a} (23.4–29)
Laudato et al, 201866	Retrospective cohort study	RNC	Robotic	Mazor robotics	Navigated and conventional	O-arm			36	11	25	65	63
Lau et al, 201367	Matched cohort study	NC	Navigated	O-arm	Conventional		2006–2011	MIS TLIF	142	37	105	50.2 (13.2)	53.9 (14.6)	48.6	35.2	31.9 (6.7)	28.9 (5.8)
Liounakos et al, 202168	Retrospective review of a prospective study	RC	Robotic	Mazor	Conventional		October 2014–January 2019	Short segment minimally invasive lumbar interbody fusion procedure	485	374	111	59	62.5	43.9	37.8	31.2	28.1
Li et al, 202069	RCT	RC	Robotic	Orthbot system	Conventional		August 2018–December 2018	Posterior fusion for degenerative lumbar disease	27	7	20	47.4 (12.9)	49.9 (10.9)	42.85	40	24.3 (1.8)	24.6 (2.6)
Lonjon et al, 201670	Prospective matched controlled study	RC	Robotic	ROSA robots	Conventional		April–October 2013	Posterior fusion for degenerative lumbar spine disease	20	10	10	63.4 (11)	63.4 (11)	66.67	66.67	27.8 (4)	27.3 (5.6)
Malham et al, 202271	RCT	AN	AR	FLASH	Navigated	3D fluoroscopy	2019–2020	Open posterior lumbar fusion, exclude MIS because of necessity of bone registration	90	45	45	63.8	64	31.11	48.88
Molliqaj et al, 201772	Retrospective cohort study	RC	Robotic	Mazor robot	Conventional		2007–2015	Spinal instability due to degeneration, tumor, or trauma	169	98	71	58.3 (12.8)	54.4 (17)	51.02	50.7
Noshchenko et al, 201873	Retrospective cohort study	NC	Navigated	O-arm	Conventional		2011–2012		81	41	40	59 (9.3)	65 (9.2)	29.3	34.5
Pendharkar et al, 201974	Matched retrospective study	NC	Navigated	Any navigation	Conventional		2007–2016	Laminectomy and instrumented PLF: single level and 3–5 levels		893	893	55.6 (12.2)	55.1 (12.3)	60.8	60.2
Rajasekaran et al, 200775	RCT	NC	Navigated	3D Iso-C scan	Conventional			Spinal deformity correction using posterior pedicle screw of the thoracic spine	33	17	16	19.6 (9.3)	15.4 (4.3)	35.29	25
Ringel et al, 201276	RCT	RC	Robotic	Mazor SpineAssist	Conventional			Lumbosacral stabilization	60	30	30	68^{^a}	67^{^a}	46.67	40	26^{^a}	28^{^a}
Ruatti et al, 201677	RCT	NC	Navigated	3D fluoroscopy	Conventional		March 2011–July 2012		143	71	72
Schatlo et al, 201478	Matched retrospective study	RC	Robotic	Mazor SpineAssist	Conventional		2007–2011	PLIF and TLIF	95	55	40	52^{^a} (27–83)	58^{^a} (23-82)	47.3	30	24.7 (3.7)	28 (6.1)
Schizas et al, 201279	Prospective study	RC	Robotic	Mazor bone-mounted robotic	Conventional			Vertebral fracture, spinal stenosis, degenerative disc disease, or lumbar scoliosis; exclude thoracic scoliosis	34	11	23
Shafi et al, 202280	Retrospective cohort study	RN	Robotic	ExcelsiusGPS system	Navigated	3D fluoroscopy	April 2017–June 2021	MIS TLIF	222	92	130	59.5 (12.1)	58.5 (12.9)	51.1	53.1	27.5 (4.9)	27.9 (6.4)
Shi et al, 202181	Retrospective cohort study	RC	Robotic	Robotic system of Zhuzhens	Conventional		September 2017–June 2019	Thoracolumbar fracture underwent MIS pedicle screw fixation	30	13	17	47^{^a} (23-70)	49.1^{^a} (25-69)	61.5	52.94	24.16^{^a} (19.1–27.0)	25.13^{^a} (18.7–31.1)
Shin et al, 201582	RCT	NC	Navigated	O-arm	Conventional		January 2010–July 2010	Thoracic or lumbar spine pathology	40	20	20	57.5^{^a} (30-72)	55.3^{^a} (28-75)	60	55
Silbermann et al, 201183	Comparative study	NC	Navigated	O-arm	Conventional		January–September 2009	PLIF or TLIF	67	37	30	64.41	60.1	56.76	50
Solomiichuk et al, 201784	Matched retrospective study	RC	Robotic	Mazor SpineAssist	Conventional		June 2009–June 2015	Metastatic spine disease	70	35	35	63.7 (10.6)	62.2 (11.1)	60	65.7
Su et al, 202085	Prospective controlled study	RC	Robotic	TiRobot	Conventional		December 2018–December 2019	Posterior cervical surgeries for degenerative or trauma conditions	58	28	30	60.40 (4.99)	60.33 (5.23)	53.57	56.67	23.53 (3.22)	23.59 (2.64)
Boon Tow et al, 201586	Prospective study	RC	Robotic	O-arm	Conventional			Single-level lumbar degenerative spondylolisthesis	38	19	19	60 (11.25)	62 (18.07)
Urbanski et al, 201887	Cohort study	NC	Navigated	O-arm	Conventional		2016	Progressive idiopathic scoliosis	49	27	22	20^{^a} (11-45)	24^{^a} (12-48)	18.51	13.63
Wang et al, 202188	Retrospective cohort study	RC	Robotic	Mazor Renaissance Surgical guidance robot	Conventional		January 2017–January 2020	Open surgery for lumbar spondylolisthesis	62	31	31	57.2 (12.1)	58.6 (10.7)	25.8	32.25	26.1 (3.8)	26.4 (3.5)
Wang et al, 201989	Retrospective cohort study	NC	Navigated	O-arm	Conventional		January 2014–June 2016	3-Level degenerative lumbar disease	41	20	21	72.15 (5.58)	72.57 (6.41)	45	57.14
Waschke et al, 201390	Retrospective cohort study	NC	Navigated	CT navigation	Conventional		1995–2005	Pedicle screw instrumentation	1006	505	501
Wu et al, 201091	RCT	NC	Navigated	3D computer navigation	Conventional		2006	Pedicle screw instrumentation	42	22	20
Yang et al, 201992	Retrospective cohort study	RC	Robotic	Mazor Renaissance Surgical guidance robot	Conventional		January 2017–December 2017	Unstable lumbar spondylolisthesis	60	30	30	54 (7.7)	55.1 (8.1)	46.67	40	23.5 (1.9)	23.2 (1.7)
Yan et al, 202293	Retrospective cohort study	RC	Robotic	TiRobot	Conventional		December 2020–June 2021	Thoracolumbar pedicle screw placement	89	40	49	58.68 (11.64)	60.78 (7.78)	42.5	35	26.5 (5.14)	25.78 (3.2)
Zhang et al, 202194	Retrospective cohort study	RC	Robotic	Renaissance robot system	Conventional		January 2018–December 2019	Lumbar revision surgery	81	39	42	65.96 (7.55)	66.86 (7.32)	53.84	52.38	24.46 (2.26)	23.68 (2.58)
Zhang et al, 201995	Retrospective cohort study	RC	Robotic	TiRobot system	Conventional		March 2016–November 2017	TLIF for lumbar degenerative surgery	87	43	44	56.7 (12.5)	60.2 (10.9)	27.9	40.9	26.4 (3.9)	25.2 (2.8)
Zhang et al, 201996	Prospective study	RC	Robotic	TiRobot system	Conventional		February 2016–2018	Lumbar degenerative disease undergoing TLIF	100	50	50	54.6 (11.1)	55.6 (12.8)	34	52	25.6 (3.9)	25.3 (3.1)

Abbreviations: AC, augmented reality-assisted vs conventional methods; AN, augmented reality-assisted vs navigated methods; AR, augmented reality; ARSN, augmented reality system navigation; C, control group; CT, computer tomography; 3D, 3-dimensional; LIF, lumbar interbody fusion; MIS, minimally invasive surgery; NC, navigated vs conventional methods; PLF, posterior lumbar fusion; PLIF, posterior lumbar interbody fusion; RC, robotic vs conventional methods; RCT, randomized controlled trial; RNC, robotic vs navigated vs conventional methods; T, treatment group; TLIF, transforaminal lumbar interbody fusion.
↵a Age and BMI were reported with mean (SD) or median (range).