  In response to the growing demand for precise and affordable solutions for
Image-Guided Spine Surgery (IGSS), this paper presents a comprehensive
development of a Robot-Assisted and Navigation-Guided IGSS System. The endeavor
involves integrating cutting-edge technologies to attain the required surgical
precision and limit user radiation exposure, thereby addressing the limitations
of manual surgical methods. We propose an IGSS workflow and system architecture
employing a hybrid-layered approach, combining modular and integrated system
architectures in distinctive layers to develop an affordable system for
seamless integration, scalability, and reconfigurability. We developed and
integrated the system and extensively tested it on phantoms and cadavers. The
proposed system's accuracy using navigation guidance is 1.02 0.34 mm, and robot
assistance is 1.11 0.49 mm on phantoms. Observing a similar performance in
cadaveric validation where 84% of screw placements were grade A, 10% were grade
B using navigation guidance, 90% were grade A, and 10% were grade B using robot
assistance as per the Gertzbein-Robbins scale, proving its efficacy for an
IGSS. The evaluated performance is adequate for an IGSS and at par with the
existing systems in literature and those commercially available. The user
radiation is lower than in the literature, given that the system requires only
an average of 3 C-Arm images per pedicle screw placement and verification.
