2026 COA: 3D-Printed Guides, Navigation, and Robotic Assistance in Spinal Instrumentation .

133 studies including 20 153 patients and 88 124 pedicle screws were included in this network meta-analysis comparing 3D-printed (3DP) guides, robotic-assisted platforms, navigation systems, and conventional pedicle screw placement techniques. Pooled outcomes of interest included pedicle screw breach rates, operative time, estimated blood loss, complication rates, and postoperative pain and functional outcomes. Compared with conventional techniques, all advanced technologies improved pedicle screw accuracy. However, 3DP guides demonstrated the lowest overall breach risk, the least blood loss, and the shortest operative time. No significant differences were observed in postoperative pain or complication rates among advanced technologies. These findings suggest that 3DP guides may be the most favourable in terms of accuracy and efficiency while offering a potentially more accessible and cost-effective alternative to robotic and navigation systems.