The Role of Enabling Technologies in Spine Surgery in India: Expert Consensus Based on Narrative Review

Abstract Enabling technologies (ETs) are tools that offer safe, reliable, and consistent options to help surgeons maximize efficiency and limit surgical complications. ETs include, but may not be limited to, intraoperative three-dimensional (3D) imaging techniques and devices, advanced computer-assisted navigation (CAN) systems, surgical planning software, and robotic devices. Robotic-assisted CAN systems, when integrated into minimally invasive spine surgery (MISS) along with the use of biologics and spinal implants, have significantly improved surgical precision and workflow efficiency. Current ETs enhance MISS by reducing intraoperative radiation exposure for both patients and surgical teams. Despite the increasing adoption of advanced technologies, access to ETs in India remains uneven, particularly in tertiary centers in major cities and resource-limited regions. An expert panel discussion on spine technology was conducted to understand the need for adopting ETs in India and the current gaps in providing uniform access to spine care, ensuring enhanced safety and predictable clinical outcomes for patients requiring spine care. This review synthesizes expert insights with evidence identified through a structured literature search using PubMed, Cochrane, Google Scholar, and ScienceDirect using predefined search terms and eligibility criteria. Salient features of the present ETs used in MISS imaging and navigation, advantages of 3D technology, and robotics integration in MISS, along with emerging trends relevant to the Indian spine surgery landscape, have been presented in this article. The expert panel recommended prioritizing investment in surgeon training, technology-enabled education centers, and supportive policy frameworks to expand safe and equitable adoption of ETs across India.