To improve the accuracy of pedicle screw placement, computer-assisted navigation systems were introduced in spine surgery. The objective of this study was to compare the accuracy of pedicle screw placement and the patient outcomes in robotic-guided versus intraoperative 3D navigation techniques for thoraco-lumbar spine surgery. Among the 14 studies included in the meta-analysis, statistically significant results in favor of robotic group were described for hospital stay (p = 0.003) and pedicle screw accuracy (p < 0.00001). Robotic-guided pedicle screw fixation represents a safe and highly effective technique, showing statistically significant superiority in screw placement accuracy compared to CT-guided navigation. Robotic versus intraoperative image-based navigated thoraco-lumbar pedicle screw fixation: a systematic review and meta-analysis.