Minimally Invasive Surgery for Spinal Metastases: Robotics, Navigation, and the Evolution of Precision Spine Oncology.

Abstract

Advances in systemic therapies and stereotactic body radiotherapy have profoundly modified the prognosis of patients with spinal metastases, increasing the need for surgical strategies that minimize morbidity while maintaining oncological efficacy. This narrative review aimed to summarize the current evidence concerning minimally invasive surgery, navigation, and robotic-assisted spine surgery in contemporary metastatic spine care. A narrative review of the literature was conducted using PubMed, ScienceDirect, and Cochrane databases up to May 2026. Original studies, systematic reviews, meta-analyses, and clinical series evaluating minimally invasive techniques, and image-guided technologies for spinal metastases, were included. Minimally invasive spine surgery provides a strong level of evidence, consistently demonstrating reduced blood loss, wound complications, infection rates, drainage requirements, and hospital length of stay compared with conventional open surgery while preserving neurological and mechanical outcomes. Earlier resumption of systemic therapies further supports its integration into multidisciplinary oncological care. Navigation and robotic assistance improve pedicle screw placement accuracy and facilitate complex minimally invasive procedures, particularly in anatomically distorted vertebrae. However, evidence supporting improvements in survival, neurological recovery, construct durability, local tumor control, or other patient-centered outcomes remains limited. Contemporary surgery for spinal metastases has evolved toward tailored, multidisciplinary treatment strategies focused on mechanical stabilization, neural decompression, and rapid reintegration into oncological care. While minimally invasive surgery has become the preferred posterior approach whenever technically feasible, navigation and robotic assistance currently represent precision-enhancing technologies whose principal benefit lies in improving surgical workflow and reproducibility. Future prospective studies should evaluate their impact on clinically meaningful outcomes beyond technical performance.