Recent advances in robotic-assisted laminectomy in spine surgery: a narrative review

Robotic-assisted laminectomy (RAL) is an emerging technique in spine surgery that can potentially improve precision, safety, and efficiency. While robotic-assisted pedicle screw placement is well established, RAL remains in early stages with varied methodologies and primarily pre-clinical validation. This narrative review evaluates current evidence on RAL, focusing on bone cutting tools, resection strategies, state recognition techniques for real-time identification of bone type and surgical endpoints, and clinical applications to inform future advancements. A comprehensive literature search was conducted using PubMed, Embase, and Cochrane databases with relevant keywords and operators to maximize sensitivity. Twenty-seven studies met predefined inclusion and exclusion criteria. Evaluated cutting tools included burrs, drills, and ultrasonic osteotomes. Burrs and drills provided superior state recognition feedback, while ultrasonic devices offered better force control and reduced thermal damage. Cyclic dorsal-ventral drilling was found to be superior to layer-by-layer resection for ultrasonic cutting. The only clinical study of RAL in a human patient is a case report demonstrating robotic-guided, surgeon-operated laminar bone removal. While RAL shows promise in improving surgical accuracy, the lack of in vivo data and standardized methodology remains a key barrier to clinical adoption. Future research should prioritize comparative evaluation of cutting modalities, clinical validation in human subjects, and long-term outcome studies to support the broader integration of RAL into spine surgery.