Mazor Robotics has emerged as a key player in the eld of robotic spinal surgery, revolutionizing the way procedures are performed through its advanced robotic sys­tems. Mazor Robotics was founded in 2001 by Professor Moshe Shoham and Elad Benjamin in Israel [20, 21]. The duo’s expertise in robotics and engineering led them to envision a system that could assist surgeons in achieving greater precision and safety during spinal surgeries. Their rst robotic system for spine surgery, SpineAssist, was the only device that gained FDA clearance from 2004 to 2011, and provided real-time rigid stereotaxic guidance to improve accurate implant place­ment with lower complication rates [22]. The initial device was used for lumbar degenerative disease with the primary goal of facilitating minimally invasive screw insertions (even percutaneous) accurately while reducing the need for excessive intraoperative radiation exposure. In 2006, the robotic process was more heavily applied to the challenges of complex pediatric spinal deformity cases. The strength of SpineAssist was its small footprint, and because the device mounted to the spine, patient movement (such as respiratory uctuation and soft tissue retraction) was well tolerated. The device is a 50 × 90mm cylindrical hexapod unit with a base plate and top plate that weighs 400 g. It has six actuator struts that move the top plate against the base plate in four planes with a motion control resolution of 10 microns. An effector arm tted with a drill/tap guide is attached to the top plate. The invivo targeting accuracy of the drill/tap guide is <1 mm, including CT and C-arm distor­tion [22]. The robot’s bottom mounting plate mounts to the patient via a three­position rail attached to the previously placed reference marker. The three-position rail is best for complex scoliosis cases, adapting to the curvature and rotation of the spine. Optionally, a T-shaped 14-position rail mounts across the patient’s posterior iliac spines and a proximal spinous process, and the reference marker is attached to one of the position stations during image registration. This latter rail is best for lon­ger constructs with minor scoliosis or minimally invasive percutaneous cases (Fig.7.1).