Evaluation of Robotic Surgery in Pediatric and Adolescent Populations for Posterior Approach Instrumentation - a Systematic Review, Single-Arm Meta-Analysis and Meta-Regression

Purpose Robot-assisted (RAS) surgery is increasingly used in pediatric and adolescent posterior-approach spine surgery. However, current literature often focuses on pairwise comparisons, limiting comprehensive evaluation of robotic effectiveness across diverse conditions. This single-arm meta-analysis aimed to evaluate the effectiveness of RAS in pediatric and adolescent spine surgery. Methods A systematic search was conducted across PubMed, Embase, Scopus, Web of Science, and Cochrane Library from inception to December 2024. Studies were included if they reported outcomes of RAS for pedicle screw placement in patients under 25 years with spinal deformities. The primary outcome was the accuracy of pedicle screw placement, assessed using the Gertzbein and Robbins (GR) grading system. Secondary outcomes included intraoperative metrics and deformity correction. A random-effects model was applied for meta-analyses. Results Fifteen studies encompassing 13,325 screws and 920 patients were included. The pooled rate of clinically acceptable screws (GR A+B) was 95.66% (95% CI: 94.04–97.28), with 88.54% (95% CI: 83.60–93.48) achieving perfect placement (GR A). The incidence of heavily misplaced screws (GR D+E) was 0.59% (95% CI: 0.18–1.16). Blood loss averaged 687.85 mL (95% CI: 534.27–841.43), and the mean operation time was 306.03 minutes (95% CI: 273.19–338.88). Curve correction rates and Cobb angle improvements were consistent with existing scoliosis treatment benchmarks. Heterogeneity was observed, likely due to variability in study designs, robotic systems, and patient populations. Conclusion RAS demonstrates high accuracy and safety in pediatric and adolescent spine surgery, with low rates of screw misplacement and acceptable secondary outcomes. While these findings highlight the clinical benefits of robotics, high heterogeneity and limited long-term data necessitate further research. Standardized reporting, longitudinal studies, and comparative analyses are essential to fully realize the potential of robotic systems in pediatric spine surgery.