Abstract Background Robot-assisted open surgery (RA-OS) is now commonly used in traditional open-exposure spinal screw placement surgery. With the help of robots, robot-assisted minimally invasive surgery (RA-MIS) can achieve less bleeding and less tissue damage in percutaneous screw insertion. While the research comparing the safety and accuracy of screw placement between RA-MIS and RA-OS is insufficient. This study aims to compare the effects of RA-MIS and RA-OS in thoracic and lumbar spine. Methods This was a prospective cohort study evaluating 208 patients undergoing robot-assisted screw insertions from July 2020 to September 2021. Age, BMI, gender, screws accuracy, screws Gertzbein–Robbins grade, small joint invasion and perioperative outcomes (operation time, blood loss, postoperative hospital stay, comorbidity) were collected. A subgroup analysis was also performed according to disease, namely fracture, spondylolisthesis, and disc herniation. Data were analyzed using Stata/MP 14.0. Wilcoxon’s signed rank test, Kruskal–Wallis test and Fisher’s exact test were used for statistical tests and p