METHODS Systematic review. OBJECTIVE To evaluate the global adoption, technological advancement, and clinical impact of neuronavigation in spinal surgery. BACKGROUND Neuronavigation has advanced spinal surgery, offering unprecedented precision and safety. This study explores the development, adoption, and impact of neuronavigation in spine surgery globally, focusing on technological advancements and their clinical implications. METHODS We conducted a systematic literature search across PubMed, Embase, and Scopus (January 1, 1990-November 5, 2024) focusing on studies related to the use of neuronavigation in spinal surgery in human subjects. Data extraction included citation counts, Relative Citation Ratios (RCR), Altmetric scores, procedural applications, and geographical distribution. RESULTS A total of 109 publications reporting on 8074 patients met the inclusion criteria. The annual number of publications increased significantly over time ( P =0.0003). Optical neuronavigation systems were the most widely used globally (69%,) with a significantly higher number of users in the United States than abroad (82% vs. 66%, P <0.001). In the most recent decade, adjuncts to neuronavigation included intraoperative CT, ultrasound, and robotic systems. Fixation was the predominant procedure (77%), followed by minimally invasive surgery (17%) and tumor-related procedures (4%). The top 3 clinical outcomes/benefits included: improved accuracy in instrumentation placement (63.3%, P =0.0019), reduction in complications (45.9%), and decreased radiation exposure (26.6%). Cohort studies were the primary study design (83.5%). Studies from high-income countries (HIC) were significantly more than those from low- to middle-income countries (LMIC): 82.6% and 8.69%, respectively. The median citation count was 23 [IQR 6.5-82] and RCR was 3.54 (IQR 1.24-6.51). Despite a lower number of studies originating from the United States (N=17), they demonstrated significantly higher impact metrics, with a median citation count of 69 (IQR 20.5-93) and an RCR of 5.31 (IQR 3.43-6.53). CONCLUSIONS Neuronavigation has significantly impacted spinal surgery, particularly in HIC, as evidenced by higher citation metrics and adoption rates. The disparity in global research contributions underscores the need for increased support and collaboration to extend benefits of neuronavigation to LMIC/LIC.