Spine surgery’s robotic revolution may have hit a wall as the reported use of the technology flattened in recent years for lumbar and cervical cases, according to the American Spine Registry’s 2026 data. Several variables factor into this from costs to market saturation, but there could be more to the numbers, physicians say.
Spine surgeons discuss the findings and what needs to change to grow adoption of robotics.
Note: Responses were lightly edited for clarity.
Question: According to the American Spine Registry’s 2026 report, robotics use and computer assistance in spine surgery has flattened since 2020. What factors are driving this? What needs to happen to change this?
M. Craig McMains, MD. OrthoIndy (Indianapolis): Two things. First is market saturation among early adopters. The thought leaders and surgeons willing to embrace new technology and workflows have already converted. Second is cost. These systems have never been cheap, but the robotic space especially has skyrocketed in both price and complexity. Nearly every platform launched in the last few years bundles a preferred imaging acquisition device and locks surgeons into proprietary posterior fixation ecosystems. Multiple major device companies have entered or re-entered the robotic space simultaneously, and each one brings its own closed ecosystem that drives up cost and limits flexibility. To borrow a phrase: “the rent is too damn high.”
What changes this is a reliable, safe system built on the latest technology that can actually expand the market, particularly into the ASC space where cost sensitivity and footprint constraints are real. The work I’ve done with ATEC on their Valence platform has had this exact issue in mind. It’s been built from the ground up for MIS and lateral access with the latest navigation technology, rather than retrofitting an expensive, old tech into new workflows. Hospitals and ASCs don’t need a shinier Ferrari. They need a fleet of Toyotas.
Lali Sekhon, MD, PhD. Reno (Nev.) Orthopedic Center: I am biased. I think surgeons have realized the value proposition for robotics beyond navigation is pretty limited. Million dollar drill guides and good for marketing. The reason for the flattening: early adopters have hopped on, but mainstream is more cautious, and right now it’s like buying an iPhone 1.
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): I would strongly question the validity of this report. There is likely a significant selection bias of the surgeons participating in this registry being not the ones that increasingly use robots and computer assisted navigation in spine surgery. I personally do not participate in any registry due to the costs and time commitment required. I would rather dedicate those resources to providing excellent care for my patients. From 2020 to now I have personally witnessed a tremendous growth in the use of robotics in spine surgery by myself and my peers. This can be easily corroborated by simply looking at the publicly available reports of spine surgery robot sales by Medtronic and Globus Medical during that time.
While the growth is certainly present, there are still significant challenges to wider adoption of robotic and navigation technology in minimally invasive spine surgery. The two most likely reasons are the costs associated with the initial equipment purchase as well as the learning curve not just for the surgeon but for the entire OR team to make the process efficient and reproducible.
I am confident that with time and greater competition, the cost of the robotic systems will go down. As more younger surgeons graduate from their training programs that include minimally invasive, robotic-assisted, and navigated procedures, there will be even wider adoption of this technology. Another factor that will help wider adoption of this technology is expanding the capabilities of the robotic systems beyond hardware placement.
David Skaggs, MD. Cedars-Sinai (Los Angeles): This plateau matches my practice. Robotics can be a true clinical advance in selected cases — spondylolysis repair, for example, can be done with less dissection and smaller incisions, and likely improved precision. But for large deformity correction, current systems often add hassle: more exposure, incisions and workflow steps, longer operative time, and frequent line-of-sight interruptions. Accuracy degrades as you work farther from the reference array — an issue in long constructs. Add high capital cost, training/staffing demands, and some marketing-driven adoption and flattening isn’t surprising. To change this, platforms must be faster and simpler, maintain accuracy across multiple levels, reduce line-of-sight dependence and demonstrate clear outcomes and ROI.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): Keep in mind that interpretation may be limited because more than 80% of cases do not report whether these technologies were used, making trends difficult to measure completely.
Several factors are likely contributing to the flattening adoption curve. First, economic pressures are significant. Robotic platforms require substantial capital investment, and in an era of tighter hospital margins, bundled payments, and increasing migration of spine procedures to ASCs, many systems are hesitant to adopt technologies without clear economic return.
Second, a gap remains in our evidence between the improvement seen in various technical metrics (ie screw accuracy) and actual clinical improvements, as measured by patient reported outcomes and/or total episode-of-care costs. So, without clear value-based data, administrators may view these technologies as incremental rather than the transformative instruments that surgeons and industry tout.
Finally, workflow integration and operational complexity can slow adoption, particularly in high-volume practices where efficiency is critical.
For adoption to accelerate, technologies will need to demonstrate more “clear value.” Sure, that in itself can be difficult to define, but there needs to be clearer evidence of improved outcomes, efficiency, or overall cost of care, while becoming more scalable and compatible with outpatient spine surgery environments.
Vijay Yanamadala, MD. Hartford (Conn.) Healthcare: The flattening isn’t surprising to me, and I’d argue that it’s clarifying.
But first, a terminology problem worth naming: what we call “robotics” in spine surgery is not what most people picture when they hear that word. The da Vinci system actually performs portions of an operation — the robot moves, cuts and sutures. Spine “robots” do none of that. They are sophisticated positioning and guidance systems. The surgeon still makes every incision, places every implant, and executes every maneuver. The robot holds a targeting arm steady and confirms trajectory. That’s a meaningful distinction, and the conflation of the two has created unrealistic expectations on both sides — among patients who assume more automation than exists, and among hospital administrators evaluating capital purchases.
With that framing, the flattening makes sense — and I hear a specific question come up repeatedly among experienced spine surgeons: “I already have navigation. It’s mature, it’s accurate, it’s been refined over two decades. Why do I need another passive tool to do what navigation already does?”
That’s not resistance to innovation. That’s a legitimate value question. Intraoperative navigation has become highly precise, and for many surgeons it already closes the accuracy gap that early robotic systems were marketed to address. If a robotic system’s primary selling point is trajectory confirmation, and navigation already provides that, the incremental benefit doesn’t justify the cost or the workflow change.
I speak from personal experience here. I trained on robotic systems when they first came to spine surgery. At the time, I didn’t see sufficient clinical benefit to justify the tradeoffs — the cost, the setup time, the workflow disruption. So I waited. I returned to it recently, performing a two-level MIS TLIF as a deliberate opportunity to evaluate the technology on its current merits rather than its early promise. The hardware has meaningfully improved. But my core assessment held: these remain passive tools.
And that’s the deeper issue — one that applies equally to navigation and current robotic platforms. Both show the surgeon where to go. Neither helps decide whether to go at all, how to sequence a complex deformity correction, or how to anticipate intraoperative variability. We’ve built increasingly sophisticated GPS systems for a road that still requires a highly skilled driver.
What needs to change is the underlying value proposition. The next generation of surgical technology needs to move from navigation assistance to surgical intelligence — tools that synthesize preoperative imaging, intraoperative data, and outcomes evidence to actively support decision-making in real time. That’s a meaningfully different category than what most current platforms offer, and it’s where the field needs to go.
Jacky Yeung, MD. Yale School of Medicine (New Haven, Conn.): The flattening of robotics and computer-assisted spine surgery since 2020 likely reflects a pause between early enthusiasm and broader value-based adoption. Early uptake was driven largely by innovation momentum and competitive positioning among hospitals. Robotics clearly improves precision in areas such as pedicle screw placement, but many surgeons can achieve excellent results with previous-generation navigation. Without consistent evidence demonstrating reductions in complications, revisions, or length of stay, many hospitals have been cautious about making additional multimillion-dollar capital investments. Now health systems who in general are facing immense financial pressures are asking: does the technology meaningfully improve outcomes, efficiency or cost of care?
For adoption to accelerate again, robotics will need to move beyond being viewed primarily as a targeting tool. The real inflection point will come when these systems become integrated platforms for surgical planning, intraoperative decision support and procedural execution. Advances in AI-driven planning, imaging integration and data analytics could significantly expand the clinical value of robotic systems.
In many ways, the current plateau may simply represent the maturation of the technology. As the evidence base strengthens and the platforms become more capable, robotics will likely play an increasingly important role in spine surgery — but adoption will be driven less by novelty and more by demonstrable value for patients and health systems.
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