High-precision spindles are a vital study topic because of the growing demand for highspeed, high-precision, reliable, and long-lasting machine tools. Bearing preload is the primary means of improving the accuracy of the spindle rotor system. This study aims to summarize the research results, systematically analyze and evaluate the machine tool motorized spindle variable pressure preload technology, and provide a scientific basis for the practical application of the motor spindle variable pressure preload technology. This study is an in-depth analysis of the basic principles of the electric spindle preloading technology, the study of its influence mechanism on the thermal deformation, stiffness, slewing error, and life of the spindle system, and a discussion of the current shortcomings in the field of spindle preloading to provide a reference for the subsequent optimization. In the spindle system, the performance of rolling bearings and the design of bearing preload have an important impact on the spindle's accuracy and stability. The traditional preload method has yet to meet the requirements of modern high-speed machine tools. Real-time controllable preload has become the new direction of development, but the current preload technology still has certain limitations and needs to be further improved. In the future, the spindle bearing variable pressure preload technology will be more efficient and intelligent.