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However, comparative evidence on surgical outcomes remains fragmented across different spinal pathologies and procedures,. With this work, we aim at comparing surgical and clinical outcomes of exoscopic versus microscopic spine surgery for degenerative conditions through a global meta-analysis, with procedure-specific subgroup analyses.\u00a0A systematic review and meta-analysis were conducted according to PRISMA guidelines. Comparative studies evaluating 3D exoscope versus microscope in spine surgery for degenerative conditions were included. Continuous outcomes (operative time, blood loss, length of stay, visual analogue scale [VAS] scores) were pooled using a random-effects inverse-variance model and expressed as mean differences (MD). Dichotomous outcomes (complications) were analyzed using Mantel\u2013Haenszel odds ratios (OR). Heterogeneity was quantified with I\u00b2 and \u03c4\u00b2 statistics. Subgroup analyses were performed by procedure (ACDF, MIS-TLIF, lumbar microdecompression\/microdiscectomy), along with sensitivity analyses and meta-regressions when indicated.\u00a0A total of 785 patients across 7 studies were included. No significant differences were found in operative time (MD \u2212\u20095.9\u00a0min; 95% CI \u2212\u200916.4 to +\u20094.7), complications (OR 0.83; 95% CI 0.53\u20131.30), length of stay (MD \u2212\u20090.15 days; 95% CI \u2212\u20090.84 to +\u20090.53), or postoperative VAS scores. Blood loss was slightly reduced with the exoscope (MD \u2212\u20095.9 mL; 95% CI \u2212\u200911.1 to \u2212\u20090.6), although the clinical relevance appears negligible. Subgroup analyses showed consistent findings across ACDF, MIS-TLIF, and lumbar microdecompression.\u00a0Despite significant limitations, current literature supports comparable surgical and clinical outcomes between 3D exoscopes and OM across spine procedures. Exoscopes may offer ergonomic and didactic advantages without increasing operative time, complications, or hospital stay. However, standardized quantification of performance in the former non-clinical domains is missing. Further high-quality randomized studies are needed to confirm these findings and define procedure-specific benefits.<\/jats:p>","DOI":"10.1007\/s10143-026-04275-0","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T05:12:35Z","timestamp":1775797955000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exoscope versus microscope in spine surgery: A meta-analysis based on procedure-specific subgroup analysis"],"prefix":"10.1007","volume":"49","author":[{"given":"Alberto","family":"Benato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donato","family":"Creatura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Palombi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9dric Yves","family":"Barrey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"4275_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bas.2021.100855","volume":"2","author":"A Abramovic","year":"2022","unstructured":"Abramovic A, Demetz M, Krigers A, Bauer M, Lener S, Pinggera D, Kerschbaumer J, Hartmann S, Fritsch H, Thom\u00e9 C, Freyschlag CF (2022) Surgeon\u2019s comfort: the ergonomics of a robotic exoscope using a head-mounted display. 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