{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:21:42Z","timestamp":1790194902992,"version":"4.1.0"},"reference-count":54,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: This systematic review and meta-analysis compared freehand and navigation-assisted spine surgery with robot-assisted techniques, focusing on radiation dose, fluoroscopy time, and factors influencing these outcomes. Methods: Following the PRISMA and PROSPERO protocols, we searched major databases for comparative studies on radiation exposure or fluoroscopy duration. Non-comparative, cadaveric, and animal studies were excluded. Bias was assessed with RoB 2 and MINORS. The data were pooled using random-effects models, with subgroup, meta-regression, sensitivity, and publication-bias analyses. Results: Twenty-eight studies (3205 patients) were included. Compared with freehand surgery, robotic assistance did not significantly reduce radiation dose (SMD \u22120.81; p = 0.07) or fluoroscopy time (SMD \u22120.56; p = 0.06), with substantial heterogeneity. Subgroup analyses revealed lower exposure with specific robotic systems (e.g., Tianji\u00ae), in degenerative and trauma indications, and at cervical, lumbar, and thoracolumbar levels. No differences were observed between robotic-assisted and navigation-assisted techniques. A meta-regression showed increasing an fluoroscopy time and radiation dose in more recent freehand studies, while trends were stable in robotic cohorts. No publication bias was detected. Conclusions: Robotic-assisted surgery was not associated with statistically significant reductions in overall radiation dose or fluoroscopy time compared with freehand techniques. Effects may vary by robotic platform, indication, and anatomical level; however, substantial heterogeneity limits certainty. Further randomized controlled trails with standardized reporting are warranted.<\/jats:p>","DOI":"10.3390\/jcm15062144","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T14:43:18Z","timestamp":1773240198000},"page":"2144","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Radiation Exposure in Robotic-Assisted Versus Conventional and Navigation-Assisted Spine Surgery: A Systematic Review, Meta-Analysis, and Meta-Regression of 3205 Patients"],"prefix":"10.3390","volume":"15","author":[{"given":"V\u00edctor","family":"Rodr\u00edguez-Dom\u00ednguez","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital, 28040 Madrid, Spain"},{"name":"Department of Neurosurgery, Rey Juan Carlos University Hospital, 28933 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6230-9287","authenticated-orcid":false,"given":"Catalina","family":"Vivancos S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6234-7662","authenticated-orcid":false,"given":"Mario","family":"Taravilla-Loma","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda L.","family":"Gand\u00eda-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Isla Guerrero","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, La Paz University Hospital, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"De Jesus Encarnacion Ramirez, M., Chmutin, G., Nurmukhametov, R., Soto, G.R., Kannan, S., Piavchenko, G., Nikolenko, V., Efe, I.E., Ramirez Romero, A., and Mukengeshay, J.N. 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