Minimally invasive spine surgery with endoscopy, navigation, robotics, and artificial intelligence: Clinical evidence and future directions

Table 1 Summary of advantages and disadvantages of minimally invasive spine-related technologies

Technology	Advantages	Disadvantages	Typical clinical scenarios
Intraoperative CT navigation	Accurate localization of bony structures; enhances surgical safety; reduces intraoperative errors	Increases operative cost and radiation exposure; requires high operator proficiency	Spinal fixation; pedicle screw placement; complex fracture reconstruction
Endoscopic systems (HD/4K)	High-definition visualization; reduces soft-tissue trauma; improves clarity of the operative field	Limited field of view; narrow working space; technically demanding	Discectomy; spinal decompression; laminectomy
Robotic systems	High accuracy; shorter operative time; reduces intraoperative surgeon fatigue	High equipment cost; system complexity; requires dedicated training	Spinal deformity correction; complex multilevel procedures
Sequential muscle dilators	Decrease muscle retraction; reduce postoperative pain; shorten recovery time	Applicable only to specific approaches; cannot fully replace conventional open procedures	Lumbar fusion surgery; disc procedures
Fluorescence imaging (e.g., ICG)	Improves intraoperative identification of vascular and neural structures; reduces iatrogenic injury	Requires additional equipment and contrast agents; increases procedural complexity	Complex spinal surgery in vascular-rich regions

CT: Computed tomography; HD: High definition; 4K: 4K ultra–high definition; ICG: Indocyanine green.